HLTH 4100 Week 11 Hospital Organizational Analysis Example

One Hospital Explained: An Organizational Analysis of Emergency Admissions From Structure Through Culture, Power and Group Behavior to a Single Recommendation

Student Name

Walden University

HLTH 4100: Healthcare Organization Theory and Behavior

Instructor Name

Month Day, Year

One Hospital Explained: An Organizational Analysis of Emergency Admissions From Structure Through Culture, Power and Group Behavior to a Single Recommendation

The Question

This paper explains one organization rather than summarizing eleven weeks. The organization is my own employer, a 240-bed community hospital, and the question is the one I began with: why do admitted emergency department patients wait a median of five hours for an inpatient bed here, when a similar hospital in our system moves them in about two? Each lens the course offered, systems, structure, culture, motivation, power, group behavior, conflict and change, illuminated part of the answer. This paper puts the parts together and ends with a single recommendation.

The answer turned out to have several parts that reinforce each other.

The System and Its Broken Loop

Viewed as an open system, the admission process has similar inputs at both hospitals: patients, beds and staff. The difference lies in throughput and feedback. The longest step at our hospital is the unit charge nurse's decision to accept a patient, a median of 95 minutes before the most recent change. And the feedback loop is broken: the units that control that step never see how long their admitted patients wait downstairs, because boarding time appears only in a monthly report they do not receive (Katz & Kahn, 1978).

Structure and Culture

The structure explains why the bottleneck exists. The hospital is organized by function, with emergency and inpatient units under separate directors and no one below the vice presidents holding authority across them. The comparison hospital has the same structure plus a bed manager with authority over placement, an integrating role of the kind differentiated organizations need (Lawrence & Lorsch, 1967).

The culture explains why the structure has not changed. Three episodes, from the shift-change norm to the reaction when a visiting bed manager overruled a unit, revealed shared assumptions that a unit's first duty is to its own patients, that a patient becomes the unit's concern only on arrival and that cross-unit authority is illegitimate (Schein & Schein, 2017). These assumptions make an integrating role feel like an intrusion.

Motivation, Power and Groups

The motivation analysis showed that the hospital's main incentive, a bonus for discharges before noon, rewarded earlier discharge orders rather than earlier departures, because order time was the part managers could control (Kerr, 1975). The power analysis showed that formal authority over admissions sits three levels above the problem, while informal influence sits with a few experienced people, a veteran day charge nurse and the hospitalist lead, whose support decides whether admissions move. The group behavior analysis showed how a cohesive night team, effective in many ways, excluded newcomers and protected an unexamined belief that late-night admissions are unsafe. Each finding adds a mechanism through which the structural and cultural conditions turn into delay on a given night.

Conflict and the Stalled Change

Those same conditions feed the open hostility between the emergency department and the busiest floor: two interdependent departments measured on different things, with different orientations and no mechanism to resolve disputes. And the 30-minute acceptance rule, announced in March, stalled because it was issued from the top without involving the units, did not address the shift-change norm and never shared its early gains (Kotter, 1996). The stall is the clearest evidence that the conditions identified earlier are real: a change that ignored them failed at exactly the points they predicted.

What Changed in My Own Understanding

When the course opened I assumed, as most of my coworkers still do, that boarding was a bed shortage, and that the solution was more beds or faster discharges. The analysis changed that view in stages. The systems analysis showed that inputs were similar to the comparison hospital's. The structure and culture analyses showed why the handoff between departments was slow and why it had not been fixed. The power and group analyses showed which people would decide whether any fix worked. By the end, I saw the delay as a property of how the hospital is organized rather than of what it has, which is the central claim of organization theory and the one I least expected to find true in my own workplace.

One Recommendation

The analysis points to one recommendation, carried out in a particular way. Create a patient flow role with written authority to assign admitted patients to beds and to require acceptance within an agreed time, as the comparison hospital has done. But do not impose it as the 30-minute rule was imposed. Build it together with the people whose support decides outcomes: the long-serving day charge nurse, a member of the close-knit night team, the hospitalist lead and the emergency director. Give that group authority to set the acceptance standard and to solve the shift-change problem. At the same time, put each unit's daily boarding hours on its own huddle board, and replace the order-time discharge measure with actual departure time.

This single recommendation addresses each finding: it adds the missing integrating role, repairs the feedback loop, aligns measures, works with rather than against informal power, opens the night team's assumptions to examination and follows the change steps the March rule skipped. A recommendation that addressed only structure, by adding a bed manager, would likely meet the cultural resistance seen during the influenza week. One that addressed only culture would leave staff with no mechanism for acting differently.

What This Analysis Cannot Promise

The analysis rests on interviews, observation and data from one hospital over one term, and many of its findings are interpretations. The recommendation could fail for reasons the analysis did not see, such as a staffing crisis or a change in leadership. And reducing boarding may require changes outside the hospital, such as faster acceptance by nursing homes, that no internal redesign can achieve. Organization theory offers lenses, not guarantees (Scott & Davis, 2007). What it has offered here is an explanation that holds together across many angles, which is more than the explanation the hospital started with: that there are not enough beds.

References

Katz, D., & Kahn, R. L. (1978). The social psychology of organizations (2nd ed.). Wiley.

Kerr, S. (1975). On the folly of rewarding A, while hoping for B. Academy of Management Journal, 18(4), 769-783. https://doi.org/10.2307/255378

Kotter, J. P. (1996). Leading change. Harvard Business School Press.

Lawrence, P. R., & Lorsch, J. W. (1967). Organization and environment: Managing differentiation and integration. Harvard University, Graduate School of Business Administration.

Schein, E. H., & Schein, P. A. (2017). Organizational culture and leadership (5th ed.). Wiley.

Scott, W. R., & Davis, G. F. (2007). Organizations and organizing: Rational, natural, and open system perspectives. Pearson Prentice Hall.