According to Robbins, Berman, Stagg, and Coulter ‘an organisation is a deliberate arrangement of people to accomplish some specific purpose’ (2000, p.5). In the broad spectrum of the term organisation, one may see that they ‘exist to achieve goals and objectives’ (Forrest and Johnstone 2004, p. 10). This can further be divided into the concept of producing either goods/ or services to meet the needs of the organisations existing and / or potential customers or clients. This refers to ‘providing a service rather than manufacturing or producing tangible goods such as a car or refrigerator’ (Forrest and Johnstone 2004, p. 10).
It has often been said that the ‘starting point of any organization must be its mission statement’ (Clinton and Scheiwe, 1998, p.174). Health services organisations are primarily service providers and not producers of goods. An example of this can be seen by viewing the missions statement of the Southern Area Health Service, which states it is: ‘committed to promoting, protecting and maintaining the health of the community it serves’ (SAHS Mission Statement 2002). It further emphasizes this concept by stating its purpose: ‘in all aspects of our work we strive to achieve better health, good health care by:
· making available a range of quality health care services
· advocating a ‘wellness’ approach
· encouraging individuals to participate in their own health care
· supporting and facilitating staff and community involvement in planning for the future’ (SAHS Mission Statement 2002).
According to Robbins, Berman, Stagg, and Coulter, (2000, p. 362-363) organisational structure follows organisational strategy. For an organisation to operate, it has various functions it has to fulfil, and decisions and actions taken in one organisational area will affect other areas. This is known as interdependency characteristics of systems according to Robbins et al (2000).
According to Mintzberg there are five basic parts to any organisation. These include:
1. The operating core
2. The strategic apex
3. The middle line
4. The technostructure
5. The support structure
(Mintzberg 1983, p. 262).
The concept that health service organisations are primarily service providers can be further delineated by viewing the framework or support structure of a health organisation. NSW Justice Health can be used as an example. Its mission statement is ‘Achieving measurable and sustained health care outcomes leading to international best practice for those within the NSW Criminal Justice System’ (NSW Justice Health 2005).
Justice Health organisational structure has a divisional structure (Robbins and Barnwell 2002, p.116). The CEO is overall responsible for the Organisation and thus he is at the top of the organizing board. He is responsible to the minister for health, the director general and the board. According to Mintzberg this CEO and his divisional officers would constitute ‘strategic apex,’ which plans and manages overall functions (Bolman and Deal, 1997, p.62). The CEO has six different sections (Directors and Divisions) beneath him/ her: The Director of Population Health & Centre for Health Research; the Director Forensic Mental Health; Director of Finance, Director of Corporate services; Director of Juvinile Health, and Clinical and Nursing Services.
The Corporate Services Director acts as a back up to service the organization itself – and again, is not directly responsible for service delivery to inmates (clients). According to Mintzberg (Bolman and Deal, 1997, p.62) this Division would constitute the ‘supporting staff’ as well as the, ‘techno-structure,’ which ensures technical standardization. The Corporate Services section delivers and arranges service for the organization itself. Thus a manager of employee services, information technology, business manager, learning and development coordinator and manager of commercial services are in this section.
The Director in Clinical and Nursing Services is the support arm that is most relevant to the Nursing Staff of Justice Health. According to Mintzberg (Bolman and Deal, 1997, p.62) this division would constitute ‘the operating core.’ This is where the main service delivery area is, and the area where the mission of the organization is directly fulfilled. Justice Health offers services to clients (inmates) through five main clinical streams: drug and alcohol, mental health, population health, primary health and clinical services. Clinical services relates to dental services, radiographers, pharmacists, clinical service development and quality improvement. Thus at this point the organization has a matrix or hybrid design (Montgomery, 2002) as it incorporates features of both functional and product line/ divisional design.
According the Montgomery the matrix design ‘includes both a vertical and a horizontal chain of command’ (2002, p. 271). Thus, the Nurse Unit Manager has her own direct senior, in her own vertical line of command; however, concerning ‘infection control,’ ‘public health,’ ‘mental health’ or ‘drug and alcohol’ issues the directors of these areas are also her ‘direct’ senior (from the side). This design is helpful as the expert on each subject is near to hand, yet the day to day individual service delivery to clients is the responsibility of the Nurse Manager and his or her staff.