Shifting Structures

Health care organizations encompass more than hospitals, medical systems, and physician practices. Included in the mix are third party payers, pharmaceutical companies, medical equipment developers, and vendors for health care services. Each type of organization has formed their own structure in context to the circumstances or strategy of the business. For the purpose of this discussion, I will focus my response on non-government hospitals, both for-profit and not-for- profit, as I am most interested in prevailing trends in hospitals on a national level. Hospitals have a combination of Mintzberg’s organization design elements. In nearly every hospital you see elements from the divisional form, professional and machine bureaucracy. The prevailing structure tends to develop around those who hold the power for the hospital to achieve profitability.

Until recently, hospitals were structured as a professional bureaucracy due to the strong pull to attract physicians to utilize their hospital for tests, surgeries and patient admissions in an effort to achieve profits. Prior to the past fifteen years, most physicians were in a medical practice independent of the hospital and retained the flexibility to choose what hospitals and ancillary service facilities they wished to utilize in their pursuit of quality patient care. Hospitals would surrender their power to physicians (Mintzberg, p.109) as they could not survive without the physicians’ referrals. These hospitals would market their facilities to physicians directly and indirectly by ensuring they provided the physicians with a facility that employed the best nursing staff and state-of-the-art equipment. Within the past fifteen years, more physicians are becoming employees of hospitals which has diminished their power for a professional bureaucracy to some degree.

My assertion is hospitals still retain the professional bureaucracy yet are discovering a shift toward a machine bureaucracy to meet new...