Biomed Imaging Interv J 2007; 3(3):e29
doi: 10.2349/biij.3.3.e29
© 2007 Biomedical Imaging and
Intervention Journal
Commentary
Inverting the organisational pyramid
WR Hendee, PhD
Medical College of Wisconsin, Milwaukee, Wisconsin, United
States
In any healthcare institution, the most important people are
patients and their families [1]. These people benefit from the services of the
institution, pay for these services either directly or indirectly through
third-party payers, and hence affect the marketing of the institution through
expressions of satisfaction (or dissatisfaction) with the services. They also
form a customer base for receipt of present and future services from the
institution.
A bond between an institution and its customer base of
patients and families is essential to the survival of healthcare institutions
and fulfilment of their mission as a public asset. In an organisational chart
that depicts the fulfilment of an institution’s mission, patients and their
families would be given “top billing” because they are the sole reason for the
institution’s existence.
Within an institution, the most important employees are
those who provide healthcare services to patients and supportive services to
families. These persons include the nurses, technologists, orderlies,
receptionists, and others who interact directly with patients and families
through the provision of healthcare either directly or indirectly. These are
the individuals who are fulfilling the mission of the institution, providing
safe and effective healthcare services, gaining the support of patients and
families for the institution, and thereby assuring the success and longevity of
the institution. In cases where physicians are institutional employees, they
would be included in this list of caregivers. All of these individuals should
be positioned on an organisational chart directly below patients and their
families because they are the conduit for the flow of services to patients and
families (i.e. they are responsible for assuring the institution’s present and
future customer base).
Employees who provide services to patients and families need
resources and an institutional infrastructure to help them fulfil their
responsibilities to patients and their families. This infrastructure includes
administrative personnel who can ensure the flow of necessary resources to the
employees providing services to patients. There may be multiple layers of
administrative personnel. Those working most closely with the healthcare
providers (the “sub-sub bosses”) constitute the top tier of administrative
personnel, those who support these individuals (“the sub-bosses”) comprise the
second tier, and at the bottom is the person who has the job of assuring that
all of the employees above him or her have the resources and support necessary
to do their job. This person is “the boss”, and his position is at the bottom
of the organisational chart.
“The boss”, positioned at the bottom of an institution’s
organisational chart, is responsible for assuring that the institution’s resources
and infrastructure are focused appropriately to provide the needs to enable
employees at the top of the chart to deliver quality healthcare services to
patients and families. The boss should also serve as the institution’s
principal “cheerleader” in providing an optimistic, positive atmosphere for all
of the employees positioned above him or her in the organisational chart. The
“boss” (and the sub- and sub-sub-bosses) set the stage for delivery of
healthcare services by employees of the institution who work directly with
patients and families. It is this delivery process that is fundamental to the
mission and wellbeing of the institution, which is why it is positioned at the
top of the organisational chart.
This understanding of the purpose of a healthcare
institution and how it should function is seldom portrayed in institutional
organisational charts. Instead, the charts are inverted, with “The Boss” at the
top, sub-bosses below the boss, and employees who provide healthcare services
at the bottom [2]. Patients and their families, who are the recipients of the
institution’s services, are almost never included in the organisational chart. This
portrayal reveals an introverted, self-serving way of thinking about an
institution which can be (and often is) a severe handicap to the institution’s
functionality and to its ability to deliver safe and effective services to
patients and families. This handicap disappears when an institution recognises
the need to “invert the organisational pyramid” to ensure that the delivery of
services to patients and families is acknowledged as the institution’s top
strategic and tactical priority.
Inversion of the organisational pyramid can (and should)
occur not only in the institution as a whole, but also within every organisational
subset in the institution. In a medical physics subgroup, for example,
physicists working directly with physicians and technologists in the delivery
of patient services are positioned above the “physics boss”, who is responsible
for ensuring that those in the direct line of patient care can function
optimally. Inverting the organisational pyramid does a lot to emphasise the
purpose of the institution and the importance of those who are most responsible
for carrying it out.
REFERENCES
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Braithwaite J. Organizational change, patient-focused care: an Australian perspective. Health Serv Manage Res 1995; 8(3):172-85.
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Salvadores P, Schneider J, Zubero I. Theoretical and perceived balance of power inside Spanish public hospitals. BMC Health Serv Res 2001; 1(1):9.
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Received 9 November 2006; accepted 25 November 2006
Correspondence: Department of Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, United States. Tel.: (414) 456-4402; Fax: (414) 456-6554; E-mail: whendee@mcw.edu (William R. Hendee).
Please cite as: Hendee WR,
Inverting the organisational pyramid, Biomed Imaging Interv J 2007; 3(3):e29
<URL: http://www.biij.org/2007/3/e29/>
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