Design principles for
organising how work gets done and paid for
How money flows in private businesses
In public companies
In publicly funded organisations in the NHS
the application of these ideas
in the Mid York's NHS Trust
An organisation is a device to coordinate behaviour to
get done the work the owners want done. The delegation
of the legitimate authority of the owners is organised
through a stratified management hierarchy
In both the public and private sector most are
so-called ‘bureaucratic hierarchies’. These are stratified
employment systems in which the employment contracts
It is not about style but about formalisation of power
through the delegation of authority and tasks
In this context we give attention to designing roles and
is a key device to achieve
Organisations core functions
Task ( job description)
job segmentation is a
core part of design
Designed organisations have to give attention
• clarity about primary task (the core business)
• segment work through structural and role
design ( so whole adds up to the primary task)
A designed structure
• allocates responsibility for functions
(operational, administrative and management)
•delegates authority to designated levels
•clarifies discretionary decision making
• specifies spans of control
NB They don’t do away with human judgement
Finance Strategy Clinical Services Operations HR
Surgery Medicine Elective emergency
Face to face
Things that can be manipulated in Organisations
•Access to sources of capital – investment potential
•Organisational size – mergers, acquisitions or
•Governance arrangements – who can influence
•Employment contracts (both legal and expectations)
Some people who work in the
organisation have a built in
voice in decision making
‘Common Service’ or
Some people/organisations who use
the organisation’s services have a
built in voice in decision making
Organisation by 5’s
How to co-ordinate the behaviour of the parts?
Understanding a bureaucracy v being bureaucratic
Each level has to contribute something
to the task over and above delegating tasks
and holding others accountable
The relationship between the levels has to support
• review as control
•review as motivation
•review as learning
We can choose to see professional organisations as ‘organised
anarchies’ which resist strategy making or we can focus on how
decisions and behaviour order themselves into patterns over time.
(Henry Mintzberg On Management 1989 Collier Macmillan).
The problem with this social compact of professional autonomy
has been that not only did the profession as a whole assume
autonomy for itself, but so did each practitioner
(Donald W Light After Bristol the new Professionalism
City University London Lecture 27th November 2001)
Or we can see them as distinctive
Managing with multiple hierarchies
About Roles one reason doctors judge managers harshly
Age / Sex
Low D High P
High D High P
e.g. PM CEO
low D low P
e.g. Wife Father
Expectations (rights) of participating in control of change
Previous financial ‘system’
Bid for funds
or just keep busy
( from Tax)
of needs to be
met by NHS
Diane Plamping email@example.com
e.g. workforce, facilities
Sources of Income in a Market
patient referral, patient
choice and PCB
Referral from other
What happens them?
A contrasting way of organising
Networks or Nets that work
A way of organising
Participation ( in your own right) not as a formal representative
A net’s stocks consist of good will, trust and reputation
Nets that work operate through ‘fair trade’
They promote reciprocity ( two way exchange)
What gets ‘traded’ or exchanged is
favours, time., attention, expertise, advice, contacts etc.
An ‘economy’ of requests and offers but these are not linked in
DESIGNED SYSTEMS AND NETWORKS
structured by different ‘rules’
What are the conditions of membership
(who is in or out)?
How does accountability work?
What counts, what is valued?
How is conflict dealt with?
What are the artifacts and products?
What are the sources of power and authority
and how are they manifested?
What are appropriate shaping and leading
Necessary conditions for adaptive partnerships or networks
Building Relationship: people need time to explore purpose. Sufficient people
need to understand why they are building a partnership.
Changing Mental maps: so that people can see themselves as part of the ‘whole’
and reject shifting the blame to another part of the system.
Diversity: sufficient mix of people for new possibilities to emerge.
Expectation: that change can be fuelled by resourcefulness, passion and energy,
not just money.
Iteration: people need to be able to try and try again. One- off activity id not
enough particularly if there is little shared history of collaboration.
Responsibility: the leadership task is to create the conditions so that people can
take responsibility for the behaviour of the whole and so act responsibly as they
play their part.
Future: enlarge the shadow of the future (the expectation that we are in this
together for the long haul) and enable people to se their futures as linked
The McKinsey model; 7 S’s
Culture operates at four levels as
appropriate in each community of practice :
Artefacts (paper-based organisational structures
and protocols plans and targets)
Values espoused (strategies, goals,)
Values in action ( activity patterns and behaviours)
Underlying assumptions (taken-for-granted beliefs,
perceptions, and feelings.)
The way we write history
turns every step into progress.
The alternative, and its hard,
is to tell how we do our best.