Organization and Administration Basics

Organization and Administration

• Organization: a person or group of people established to accomplish an overall goal
• Administration: principles, practices, and techniques employed in achieving objectives

Members of the Rehabilitation Team

• Interdisciplinary Rehabilitation Team: consists of a number of disciplines and is dictated by the service needs of the patient
  • Members: Patient and Family, Nurses, Advance Practice Nurses, Physiatrists, Therapists, Psychologists, Case Managers, Social Workers, Dieticians, Chaplains

Role of Team Members

• Physiatrist: responsible for Physical Medicine and Rehabilitation Management of patient’s care
  • Collaborates with other team members
• Staff Nurse: coordinates and provides day-to-day patient care
  • Collaborates with other team members, supports and coaches patients
• Physical Therapist: maximizes patient function by working with patients to improve gross motor skills
  • Collaborates with Occupational Therapist (OT) to develop strength, balance, and teaching skills
• Speech-Language Pathologist: evaluates and treats cognition, communication, swallowing disorders, and hearing deficits
  • Collaborates with team regarding patient communication needs
• Occupational Therapist: assists patients to gain maximal function in areas of ADL’s
  • Collaborates with PT to assist patients to become functional with all components of skills/ADLs
• Therapeutic Recreation: assists patients to re-enter their community and adapt to leisure activities
  • Collaborates with other disciplines to assist patients with community re-entry and leisure activities
• Respiratory Therapist: evaluates and treats a patient’s breathing, including assist of ventilation as needed
  • Collaborates with PT to increase tolerance for increased mobility
• Neuropsychologist: evaluates cognitive and behavior status, assists in the adjustment to illness/disability
  • Collaborates with team regarding cognitive and behavioral needs of patients
• Case Manager: coordinates implementation of treatment plan, communicates insurance benefit information
  • Collaborates with team to look at patient days, status of insurance to assist in planning for discharge
• Social Worker/Discharge Planner: focuses on psychosocial support, prepares patients and families for discharge
  • Collaborates with team regarding patient’s needs, communicates status of services obtained
• Dietician: oversees patient’s nutritional status, works with Physician to provide necessary dietary requirements
  • Collaborates with team to adapt diet according to patient’s needs
• Advanced Practice Nurse: conducts comprehensive assessment, integrates education, research, and consultation into clinical practice
  • Collaborates with Nursing peers, Interdisciplinary Team, and Physician
• Chaplains: supports patients in their spiritual/religious practices
  • Collaborates with team to provide support while coping with illness/disability, consistent with patient’s faith/belief
• Vocational Services: evaluates impact of illness/injury on vocation, assists patients with adaptations to return to present vocation or retraining/education
  • Collaborates with Therapists to develop, adapt, or improve skills required for return to work or school

Organizational Culture

• Organizational Culture: system of shared assumptions, values, and beliefs, which governs how people behave in organizations
• Fundamental Documents: expressions of the fundamental guiding assumptions
  • Philosophical Statement: expresses the organization’s philosophy – values and principles
  • Value Statement: supplies the why’s of the mission and offers support for the mission
  • Principles: overarching/principal guidelines for human conduct that are proven to have enduring permanent value
  • Vision Statement: future-oriented, detailed description of outcomes
  • Mission Statement: explains why the organization exists, organization’s purpose

Basic Parts of an Organization

• Operating Core: includes all those employees who themselves produce the basic products and services
• Administrative Component (Management): Strategic Apex, Middle Line, and Support Staff
• Technostructure: analysts who support the organization
• Support Services: provides indirect support

Operating Structure

• Operating Structure: the way an organization balances the division and coordination of work between employees
• Methods of Work Coordination:
  • Direct Supervision
  • Mutual Accommodation
  • Work Standardization

Factors Influencing Operating Structure

• Internal Factors:
  • Ownership
  • Mission
  • Purpose
  • Values and Philosophy
  • Production Technology
  • Strategic Direction
  • Age
  • Size
• External Factors:
  • Industry needs
  • Performance Benchmarks
  • Environmental Stability
  • Environmental Complexity
  • Market Stability
  • Market Competition
  • Environmental Predictability
  • Legal Climate

Organizational Structure

• Organizational Structure: defines the relationships among and between the parts of the organization
• Organizational Chart: graphic representation of structure
• Solid Lines: represent direct reporting relationships
• Dotted Lines: represent communications and/or indirect control

Organizational Development

• Stages of Organizational Development:

  • Craft Stage
  • Entrepreneurial Stage
  • Bureaucratic Stage
  • Divisional Stage
  • Adhocracy/Matrix Stage### Organizational Structure

• Adhocracy/Matrix Stage is an alternative to traditional bureaucratic structure, a hybrid between traditional bureaucratic and product line structures.

• It has a Chief Executive Officer (CEO) and a Chief Operations Officer (COO).

• Program Managers report to the CEO and are responsible for different departments.

Department Structure

• Each department has a Department Manager, staff from all clinical and support departments, and serves patients in a specific product line.
• Departments are divided into different sites (Site 1, Site 2, Site 3) with their own managers and staff.

Reasons for Changes in Organizational Structure

• Failure to meet quality, productivity, or financial goals.
• Changes in purpose and fundamental documents.
• Changes in popularity.

Organizational Assessment

• Includes division of work, employee relationships, employee skill needs, methods of work coordination, number and type of people employed, work group composition, work process, and work standards (policies, procedures, and protocols).

Steps in Reorganization

• Identify gaps between current organizational performance and expected performance.
• Assess the organization (internal and external).
• Identify solutions.
• Reorganize the structure.
• Formalize all changes.