Communication is an essential skill, demonstrated and appraised during an interview process, so why are so many problems within the workplace attributable to poor communication? In a recent study conducted in Northern Ireland as part of a Master in Public Administration, John McEntee evidenced how an organisations structure and model of service delivery impacts on internal communication and organisational performance.
The most easily identifiable structure in healthcare organisations is the hierarchical organisational structure. This structure tends to have clearly defined employee roles and defines the nature of their relationship with other employees. Hierarchical organisations are often tall with broad bases with a narrowing span of control as one progresses up the structure. They can be depicted as pyramidal. They are often centralised with the most important decisions being taken by senior management. The organisation which hosted this study has a deep vertical structure which is one of the likely reasons why staff report issues such as adherence to a strict chain of command, poor communication and a disconnect with senior management.
Alternative supplementary organisational structure models are observed including the matrix structure. This type of structure is also evident within the organisation, particularly where there are professional specific clinical lead positions. Literature concludes such posts can improve communications and disseminate good practices across the organisation. The interviews and focus groups which were conducted also provide evidence that communication is improved where front line staff have professional support from clinical lead posts.
The more we turn up the dial on command and control, the more that this erodes staff’s confidence in the system and so professional dedication declines and trust is less effective.
Literature suggests that models of organisational design have evolved from vertical to horizontal to partnership designs. The study, supported by literature, acknowledges the limitations of traditional designs and proposes a horizontal design that ‘reshapes the internal boundaries …in order to improve coordination and communication,’ (Anand and Daft 2010). The emphasis shifts from establishing departments based on functions towards workflow processes. This model professes to address some issues identified by research participants in this study such as rapid communication, greater empowerment, and offers benefits to service users such as faster more responsive decision making (Anand and Daft 2010). Table 1 shows the features of the horizontal design.
Partnership designs are the most recent evolution of organisational structures but their application is more fitting for businesses that can outsource work functions, for example, in manufacturing or service industries. One might suggest that the organisation which hosted this study can provide examples of a partnership design in their outsourcing of recruitment services to Business Services Organisation (BSO). Participants interviewed identified many issues with this partnership approach which have a direct impact on staff satisfaction.
|What is it?||Breaking down internal boundaries and vertical silos to make subunits work together horizontally.|
|When to use||When the organization can create better value by improving internal coordination to enable greater flexibility and tailored responses to fit customer needs|
When to use When the organization can create better value by improving internal coordination to enable greater flexibility and tailored responses to fit customer needs
Table 1 Design features of the horizontal organisation From: Anand and Daft (2010).
An organisation’s physical structure has a strong effect on its communication style (O’Hair et al 2005); so too does its vision. Health and social care organisations, such as the one hosting this study, subscribe to a vision which aims to improve the lives of its service users. A review of an organisational model should also take cognisance of models of service delivery such as those proposed by Le Grand (2007).
Le Grand (2007) proposed alternative ways of delivering public services such as health and social care. He proposed four models: Trust, Command and Control, Voice, Choice and Competition. Le Grand’s theory suggests that there needs to be a balanced approach drawing on all four archetypal models of organising public services. In particular, the very fact of voice and choice/competition means that senior management can rely on external forces to ensure services work better, rather than trying to command/control everything.
Similarly, senior management can and should trust the professional ethics and dedication of their staff, and not try to control everything. You can’t have it all… the more we turn up the dial on command and control, the more that this erodes staff’s confidence in the system and so professional dedication declines and trust is less effective. For an organisation to be effective it must be able to provide a fair and equitable service to its service users whilst also fostering a motivated, innovative and engaged workforce. A review of organisational structures must provide advantages to service users as well as contributing to a happy and effective workforce.
Adherence to hierarchical structures creates unsupportive working environments at times. The head of service (HoS) should reflect on when it is appropriate to short circuit the existing chain of command communication structure to maximise the accuracy of information flow and to mitigate organisational silence (Morrison and Milliken 2000). This is relevant to the two-way flow of communication between front line staff and managers at different levels within the organisation. This action is necessary to prevent over centralising communication. Reduced unnecessary filtering and reduced distortion of information are the intended consequences. To implement this action would require a process of reframing of minds by the Team Leader and HoS.
Structures and service delivery models ought to meet needs of service users but also which creates nourishing, innovative environments for a thriving workforce. Organisations cannot achieve one without the other.