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It becomes increasingly difficult to ignore the fact that organizational structuring has a direct impact on strategic decision making of any company. Healthcare industry is not an exception. Many healthcare organizations attempt to optimize their corporate structures according to the prevalent market trend or specific strategic objectives. Nevertheless, a wrong choice of organizational structure or, to be more precise, its appropriate deployment may result in adverse outcomes. Such issues are usually profound and complex, as they need a respectively sophisticated approach to their investigation and analysis. A case of Queenly Community Health Service is quite peculiar due to the fact that it experiences a complicated organizational problem, which is related not only to the bottom line of QCHS performance but also to basic managerial issues of organizational structuring and strategic decision-making. Thus, the following paper provides a detailed account of this case study from the perspective of organizational theory and strategic decision-making.
Brief Case Description
In order to analyze the case presented, first of all it is necessary to admit that Queenly Community Health Service operates within quite a large territory and offers a wide range of healthcare services. Among these services, general and special counseling are some of the most demanded services, as long as QCHS has an access to a large and diversified community. The organization allocates its counseling services according to two principles: referred counseling and self-referred counseling. Patients attend initial counseling appointments and undergo assessment, which determines the prescription of general or special counseling services. Initially, clients had been expected to wait up to 3 months before they were assigned to a prescribed course of counseling. However, the waiting time for a growing number of patients ranged from 4 to 6 months. This tendency was largely observed within a year, so that the organization started losing its competitive advantage, meanwhile specific changes in organizational governance had to be introduced.
Nonetheless, many patients need an immediate intervention, but QCHS lacks workforce and cannot allocate sufficient finances to address a growing demand. Instead, consumer price increase has been chosen as a response to the existing trend due to the fact that the organization is unable to afford workforce value increase. Therefore, the company is supposed to make a certain decision concerning such a difficult situation to address a growing demand. It becomes increasingly apparent that the core of the problem lies in the organizational structure and its strategic alignment. Understanding of the organizational structure as a manageable strategic asset will enable the company to cope with its current problems and optimize further customer inflow according to its strategic and organizational potentials (Navigate Team, 2016). Queenly Community Health Service is supposed to make numerous changes and reconsiderations of its strategic and organizational management in order to sustain its business in the long run.
Discussion of the Problem
From the perspective of organizational theory, Queenly Community Health Service deploys an evident form of professional bureaucracy. High standardization and systematization of key operational processes suggest that the organization is likely to adjust its strategic and financial model to the current organizational structure instead of doing vice versa. Such organizational layout is quite acceptable for healthcare providers, but QCHS irrelevantly practices workflow standardization (Evans, 2014). As a result, the company’s counseling referral workflow is obviously redundant. The system involves unnecessary action triggers and denies the diversified approaching of patient assignment, so that the practitioners do not have an opportunity to act freely (Evans, 2014). They are expected to perform under such circumstances even though a more optimal approach can be practiced. Therefore, it is fair to admit that QCHS actually performs under a so-called street-level bureaucracy, which complicates workflow processes instead of automatizing them.
Consequently, the process of evaluation of the patients’ cases is initially ineffective, as long as it is recognized as an independent action, which requires a standard. Standardization can be observed as a serious problem in this respect, especially considering the fact that QCHS does not operate with sufficient patient information to address standardization in an efficient and beneficial way (Cummings & Worley, 2015). That is why counseling referral process is present in the form described in the case. Such evidence is quite apparent due to the fact that Queenly Community Health Service does not initiate any other attempts to regulate and optimize its workflow processes in some other way. Lack of patient data and related facilities for its processing produces an adverse effect on the provision of the counseling services in QCHS. It becomes clear that inappropriate management of organizational structure is the primary cause of these problems.
According to the reasoned action theory, the organization lacks effective workflow structures, which can be aligned with strategic decision-making. Counseling services include unnecessary trigger of referral action, which actually slows down the entire workflow of counseling services (Orr, Thrush, & Plaut, 2013). Besides, the lack of workforce can be observed, so that the increase of customer price is not a justified solution. Instead, rendering a better employee value would be a more reasonable solution. The organization does not design its workflow according to the reasoned performance that is aligned with the distinct strategic objectives, and thus its strategic decision-making is neglected (Mosadeghrad, 2013). Decision-making is extremely limited in this organization, and this tendency negatively affects reasoned actions at the bottom line of QCHS performance (Orr et al., 2013). In such a way, absence of a reasoned workflow and persistence of excessively standardized decision-making mutually cause their presence in QCHS counseling services, thereby thwarting the organization from realizing its key strategic capacities.
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Taking into account the argument regarding the reasoned action theory, it is necessary to admit that QCHS does not consider a casual indicator of a triggering action of referral. As a matter of fact, waiting is casual indicator in this case, while reasoned action theory suggests that addressing of casual indicators is an adequate reasoning of workflow procedures within the organization (Hennessy, Bleakley, & Fishbein, 2012). The healthcare provider has to find a reasonable approach to referring counseling patients through the identification of measurable dependencies, which are evidently present. Nevertheless, such a solution requires major changes in the workflow and organizational management of Queenly Community Health Service, which is why this solution has to be strategically aligned with the current objectives of QCHS (Hennessy et al., 2012). At the same time, such scenario is hardly possible as long as the distribution of decision-making is limited within the organization. Hence, a reasoned action approach should take a top-down orientation to reach sustainable optimization of strategic decision-making and efficient operations management.
Thus, implementation of information technologies to facilitate human performance is the primary concern for the automated performance and referral of counseling service patients. Human performance is highly standardized but it is not automated and is facilitated by such an important component of organizational structure as support staff (Pai, 2015). The organization loses its strategic advantage, because the demand for counseling services is extremely high, but the healthcare provider is unable to process all requests on time. Presence of support staff and related facilities is a preexisting requirement to addressing the problem (Pai, 2015). Organizational structure, however, is still inappropriately managed because the key operations are not adjusted to the strategic performance of Queenly Community Health Service. That is why the organization may need to amend its business orientation, as professional bureaucracy can be hardly managed within the healthcare company that has a diversified horizontal structure (Pai, 2015). Henceforth, the company has to implement changes on various levels of its governance and structure.
It is no surprise that QCHS has to switch its orientation from professional bureaucracy to machine bureaucracy. Healthcare industry is the most standard-driven segment of business that depends on legal regulations, so that healthcare organizations should be especially careful with managing their workflow and organizational structure of decision-making (Lunenburg, 2012). If human-based referral of counseling patients is proved ineffective, standardization should be obtained in a more automated environment. Therefore, machine bureaucracy is an important consideration, since information technology can be standardized without losing the strategic time and related expenses. Healthcare practitioners, however, will have to obtain certain freedom of action and decentralized decision-making within their professional boundaries, meanwhile the information system will standardize all the related information and final decisions (Lunenburg, 2012). Such mechanism will optimize workflow processes and considerably reduce costs required for patient data processing, storage and distribution. The data can be easily traced, so that the decentralized decision-making of counselors can still be verified for quality assurance and control.
Queenly Community Health Service is recommended to keep its strategic governance and centralize its financial management but decentralize its horizontal branches. Each horizontal representative should be governed on the basis of executive leadership, as standardization of basic procedures is pivotal for healthcare organizations (Marcinko & Hetico, 2013). Generally speaking, practitioners should adhere to decentralized decision-making, meanwhile executive representatives and top managers should be aligned with strategic objectives of QCHS. Practitioners should be instructed on what they are expected to deliver, although a narrowed framework for how it has to be achieved is not recommended (Marcinko & Hetico, 2013). Instead, the chief executive team is advised to initiate the implementation of an expanded information system to maintain business performance and facilitate workflow of horizontal practitioners. That will enable the company to integrate and strategically adjust all decision-making processes within the organization with minimal costs and without losing the strategic advantage.
The organization needs a simple but a systematic approach to the change of its organizational structure and management. That is why information system should be positioned as a central unifier of all horizontal and vertical decision-making processes. Queenly Community Health Service is advised to rely on machine bureaucracy with an emphasis on the support element of the organizational structure (Grol, Wensing, Eccles, & Davis, 2013). Standardized mining, delivery and storage of data will automatically standardize all operations inside QCHS, as long as it becomes a preexisting shaping for them. Standards will become a strong aligner of strategic decision-making rather than a professional burden for practitioners (Grol et al., 2013). It is no surprise that the implementation of the information system should in this case be recommended for the benefit of Queenly Community Health Service. Furthermore, a large prevalence of IT in healthcare environment is not a challenge any longer. Therefore, QCHS should focus all its executive force on the incorporation of an extensive IT network.
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Involvement of IT
To be more specific, the organization needs a proactive use of Cloud-based Electronic Health Record necessary for addressing the problem of counseling services. Such practice is infrequent, if EHR is used for physician-related cases, but the design of a specific referral application and development of customer-intelligent referral model is quite possible (Santilli & Vogenberg, 2015). Beyond a doubt, Queenly Community Health Service might need to spend certain amount of finances on the development of such software and its subsequent maintenance in the general ERH network (Santilli & Vogenberg, 2015). This risk is well-justified, because the use of IT applications is commonly recognized as a cost-effective solution. It is reasonable to make a prediction that information technologies are underestimated in QCHS, since the organization experiences difficulties with operations management and workflow optimization. Upgrading of information system will result in making IT occupy a higher executive level inside the healthcare company.
This step will oblige the entire company to make changes towards the optimization of organizational structure, workflow, and strategic decision-making on a large scale. First of all, operating standardized data will provide practitioners with their independent decentralized decision-making, thereby boosting referral procedure and facilitating customer inflow (Boje, Burns, & Hassard, 2012). Secondly, involvement of counseling services in the EHR network will integrate them with other horizontal components of QCHS, so that the organization will become easier to align with its present strategic orientation. Thirdly, chief executives will be enabled to trace trends for each horizontal aspect of the organization and thus adjust practitioners’ performance to the achievement of distinct and measurable goals (Boje et al., 2012). Top management will still be centralized but it will have an opportunity to best orient their subordinates and make their performance more flexible, meanwhile meeting a standard is a preexisting automated process. The vertical organizational component will directly benefit from a more profound use of IT, while the horizontal elements will have to undergo specific changes.
As it has already been mentioned, the implementation of an expanded information technology network will challenge horizontal components of Queenly Community Health Service. It is certainly true, as IT requires an interdisciplinary approach to its implementation. Provision and reliance on support staff should become a central driving force for implementing these changes because practitioners will need to adjust, train, and practice according to new working facilities (Bushe & Marshak, 2015). IT network has to be a reliable facility asset; that is why support and maintenance are of crucial importance in this respect. Moreover, IT specialists should cooperate with counseling experts to develop a reliable application. It is fair to note that IT support is a central driving force of organizational change within QCHS, but its functionality is tailored to serving healthcare purposes (Shani, Passmore, & Woodman, 2012). Information technologies and support workforce play a significant role in the case of QCHS, but practitioners are still the main executives of all procedures, so that their acceptance of change should be guaranteed.
Apart from integrating IT in the counseling practice, determination of the organizational role of IT support team should be considered. The case study suggests that Queenly Community Health Service is operating with a limited set of financial resources, so that implementation of the expanded IT network can be excessively risky. Therefore, outsourcing of lacking components is an important consideration. The company will save its costs and avoid a burden of reorganizing its IT department to full extent (OSF Global Services, 2012). In addition, QCHS will benefit from the outsourced information networking due to the reduction of inventory and equipment, improved corporate focus, gaining a competitive advantage, optimization of internal resources for better workflow management and decentralization, and preparation for a more global organizational change (OSF Global Services, 2012). The latter benefit implies that Queenly Community Health Service can establish its regular in-house platform for intelligent referral of counseling patients in case its operational performance is leveraged and satisfactory according to the market demand.
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It is appropriate to make a general comment on the fact that Queenly Community Health Service needs to make drastic amendments in its organizational structure and strategic decision-making. First of all, professional bureaucracy should be substituted with machine bureaucracy, in case QCHS does not deploy cost-effective and automated means of electronic health record and its related applications. Deployment of information technology will optimize the provision of counseling and other services within the organization, meanwhile the company itself will have to adopt multiple changes. In such a way, decentralization of decision-making for counselors and other executive decision-makers is an important consideration, while executive leadership, technological standardization and strategic planning should remain centralized. The organization is recommended to align its performance with the reasoned action theory in order to ensure a more effective workflow and transform all processes into a valuable strategic asset. However, it will require high scalability of related data within the internal information network.