An organisation

cihm.leeds.ac.uk

An organisation

Design principles for

organising how work gets done and paid for

Diane Plamping


Today’s programme

Part one

How money flows in private businesses

In public companies

In publicly funded organisations in the NHS

Part two

the application of these ideas

in the Mid York's NHS Trust


Craft work

Exchange

Use value

of goods

and services

O

Client

£

Costs

(plus profit?)

Exchange

through

price

Owner


O P

M

Client

C

C

Owner

Provider

Manager


P

P

FACTORY

O


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

are central.

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

structures.


Structure

process

organisational design

is a key device to achieve

Organisations core functions

Task ( job description)

Person

(person specification)

Role

job segmentation is a

core part of design


Designed organisations have to give attention

to:

• 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


Board

Finance Strategy Clinical Services Operations HR

Surgery Medicine Elective emergency

Gastro enerology

Paeiartics

Neurolgy


The Organisation

Administration

Front line

Face to face

with clients

Leadership

Management


Things that can be manipulated in Organisations

include:

•Access to sources of capital – investment potential

•Organisational size – mergers, acquisitions or

organic growth

•Governance arrangements – who can influence

strategic decisions

•Employment contracts (both legal and expectations)

•Management competencies.


Some people who work in the

organisation have a built in

voice in decision making

‘Corporate’

Organisation

Chambers

Governance

Usually SMEs

3-60 employees

‘Common Service’ or

Consortium Organisation

Coop

Some people/organisations who use

the organisation’s services have a

built in voice in decision making


Mintzberg’s

Organisation by 5’s

Strategic

Apex

Techno/analytical

services

‘Middles’

Support services

Service production

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


Professional Organisations

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

Permanence (P)

high

Age / Sex

Low D High P

Professional roles

High D High P

Appointed/elected offices

e.g. PM CEO

Social Networks

Friendly clubs

low

low D low P

Structural roles

e.g. Wife Father

high

Detachability (D)


Expectations (rights) of participating in control of change

Professional

hierarchy

Management

hierarchy

organisation

general

mgt.

subordinate

networks


Previous financial ‘system’

Providers/Trusts

Funders/Purchasers

Service depts.

Bid for funds

or just keep busy

Block Grant

(specified?)

£

Weighted

Capitation

grant

Level of

Expenditure

( from Tax)

Provider

Managers

Distribute

internally

Assessment

of needs to be

met by NHS

Diane Plamping diane@wholesystems.co.uk


Adjusting internal

capacity

e.g. workforce, facilities

Analysis of

competition

Sources of Income in a Market

End users

Self referral

General Practice

patient referral, patient

choice and PCB

activity

Internal

RFH

Processes

income

Payment

by Results

(PBR)

Specialist Networks

Referral from other

Secondary/tertiary

providers

PCT (+PCB)

Lead PCT/SHA

SDO

Surpluses?

What happens them?

costs

price

Tariff

Non-NHS Funders

Research Bodies

Drug companies

Insurance Companies


Networks

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

one interaction.


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

behaviours?


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

Strategy

Structure

Cold

triangle

Systems

Superordinate Goals

(purpose)

Staff (people)

Warm

square

Skills (competence)

Style


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.

William Morris

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