A healthcare organization has both formal and informal structures that occasionally conflict with one another. Formally, this healthcare organization is approaching that of a service line. It is flatter than a traditional hierarchy, with several of the bureaucratic layers removed. Yet there is a senior leadership team with official, formal authority, presiding over different departments and work groups. Wadsworth (2017) in fact recommends a similar organizational structure and design for focused healthcare organizations like this one, in which performance metrics need to be integrated with issues like billing and reimbursements, patient satisfaction data, marketing, and human resources. There are some ad hoc elements to this organization’s planning procedures, but generally the service line design does help the eldercare institution achieve its goals and objectives. As a service line structure, the healthcare organization has both centralized and decentralized decision-making processes. Some key decisions are centralized, with little if any input gleaned from other departments outside of senior management. Yet the decisions that apply more directly to patient care considerations are made in a more decentralized manner. In addition to departments, the organization has formal and informal teams, ad hoc and permanent committees, task forces, and councils. Each of these remains focused on their own role within the organization,...

Responsibility for specific issues like quality assurance and patient satisfaction is shared among various departments, and yet there are also specific workgroups within the organization that address specific concerns like these. Members of teams and workgroups will be comprised of individuals whose formal roles are within different departments. The result is the creation of pluralistic teams, which presents both opportunities and challenges for decision-making.
Each department or unit will function differently, with different styles of communication and different sub-cultures. In this way, leadership and decision-making do remain decentralized with the exception of needing to have regular meetings among managers of different departments. Within a specific department or unit, decisions are made according to various expediencies. For example, clinical care makes decisions according to evidence-based practice whereas the patient relations department makes decisions in a more collaborative manner. In the clinical care department, nurse leaders assess clinical guidelines and oversee healthcare staff. Patient care decisions are made in a team-based environment. Patient relations is a smaller department, which only occasionally interacts…