Organising As a function of management, organizing deals with identifying and grouping various activities, delegating authority and command

to managers and coordination of various activities and hierarchies in the organization. The process of organizing can be described as a series of steps as under : (i) Detailed description of various activities to be performed for achieving organizational goals : For achieving the predetermined organizational goals, we must know in detail what activities are to be performed. For example, before a hospital team can actually start treating the sick (organizational goal), they must know what equipment to buy, how many doctors, nurses and paramedical workers to hire, where to locate the hospital, how to construct and how many departments to create in the hospital. (ii) Grouping of various activities in some meaningful manner : An organization invariably functions better when activities of a similar nature are grouped together, based on their essential similarity & difference from other activities. This would be best exemplified in creation of various departments in a large hospital. For example, all patients requiring surgical intervention (which may be for hernia, burst abdomen, gun shot wound or a simple abscess requiring incision & drainage) are referred to & attended in the surgery department (which itself may be further divided into cardio-thoracic surgery, gastrointestinal surgery, neurosurgery or vascular surgery depending on the detailed type of surgeries performed). (iii) Delegation (comprising of authority, responsibility and accountability) : Consists of assigning each group of activities (departments) to a manager with authority to supervise its functioning (head of the department). Delegation, thus, is the most important part of organizing since any manager due to limited individual capabilities, can not carry out all organizational activities alone and has to delegate work to his subordinates. Successful delegation of work is accompanied by delegation of authority to take decisions & actions of accountability. (iv) Coordination (horizontal and vertical) : Makes the organizing process complete. In any organization, every individual or group of individuals very often start concentrating on performing only their specific assigned task, often relegating the overall organizational goals to the background and generating conflicts. For example, in a large multispeciality hospital, the medicine department may be unwilling to part with their assigned vacant bed in ICU in anticipation of a case even when the surgery department needs it urgently for a patient of burst abdomen. The medical stores may be refusing to issue costly medicines prescribed by a junior doctor with the aim to curb wasteful expenditure, not realizing that the medicine is urgently required by the patient. Such occurrences are quite common in medical practice and this is where the role of the medical superintendent as a manager is of utmost importance. Coordination between departments and between various hierarchies in organization is thus an essential requirement to channelise energies towards achieving the overall organizational goals and look beyond individual or departmental goals. Principles of organizing : Some important principles of organizing are enumerated below :

(i) Unity of direction : One leader & one plan for a group of activities having the same objectives. (ii) Unity of command : A subordinate reports only one boss to avoid conflict of orders. (iii) Authority : Every individual in an organization has some responsibility commensurate with his authority. (iv) Span of control : Number of subordinates supervised by a leader should not be too many for better control. (v) Flexibility : Organisational staffing pattern & structure should be able to accommodate changes in internal & external environments. (vi) Management by exception : All routine decisions should be taken by subordinates & only policy decisions and unusual matters should be referred to the leader. (vii) Scalar principle : Clear lines of authority in hierarchical structure ensures more effective performance. Formal and Informal Organisations : The organizing process results in a deliberately designed and thought out organizational structure where it is specified who will do what, with whom and under whose supervision. Such an organization is said to have a formal organization where hierarchies and levels of authority are formally laid down and observed. For example, a large corporate hospital, with its clearly and formally defined departments and its rigid hierarchy with the CEO at the top is a formal organization. On the other hand, a volunteer group of specialists who undertake charity work every weekend at a nearby charitable hospital for the poor would have emerged spontaneously due to their common likes and dislikes. Such an organization, which was not planned to come into existence and which has no formal departments or hierarchies, is an informal organization. As a doctor, one is faced everyday with informal groups, like the village elders, a village self help group, a youth club etc and we must remember that informal organizations, with expressed shared values and sentiments of a large majority, can be very effectively utilized for achieving the organizational goals. The effort to include religious leaders & volunteer groups such as Rotary Club in the Pulse Polio Immunization in India is an example where such informal groups are often more successful in achieving organizational goals than the highly formal organization of the government. Staffing The concept of span of control : Depending on the type of organization and objectives to be achieved, every manager must decide how many subordinates he/she can effectively supervise. Consequently, a wider span of control (generally found in highly technical organization with highly motivated subordinates) will result in lesser levels of management than a narrow span of control (where one subordinate is controlled only by one superior). A flat organisation (with lesser levels of management) has faster flow of information and greater satisfaction levels for individual subordinates. Such type of organization, where subordinates are highly motivated

and responsible is ideal for research and development such as in groups developing new drugs, vaccines or conceptualizing newer & better methods of health care delivery in remote villages. Factors determining an effective span of control: Though there is no laid down limit of the optimum number of subordinates a manager can supervise effectively, the most important factor is the managers ability to reduce the time he spends with each subordinate in order to gain the maximum output from him. Seven important factors which determine the frequency and duration of superiorsubordinate interaction (time spent by a superior with each subordinate, hence the span of control of each manager) are as under : (a) Training levels of subordinates : Well trained subordinates require less frequency and duration of contact with superiors & result in wider span of control for the superiors. (b) Clear delegation of authority : If a subordinates task is not clearly defined or if he is not given enough authority, he would be spending disproportionate time seeking clarifications, thereby reducing his span of control. (c) Clarity of plans : A superior would need to spend considerable time supervising & guiding the decisions of subordinates wherever subordinates have to do much of their own planning. This usually occurs whenever organizational plans are not clearly laid down. (d) Objectivity in standards : Use of tangible and measurable standards against which actual performance of subordinates is to be measured enables the manager to avoid time-consuming procedures to ascertain if his subordinates are actually following the plans. (e) Rate of organizational change : Narrow span of control becomes necessary wherever the rate of change in the organization is fast; which determines the stability of policies. Organizations with slow rate of changes (or relatively stable organizations in stable environment) would do better to have a broader span of control. (f) Communication techniques : If instructions have to be personally delivered by a superior to his subordinates and repeated clarifications have to be sought, naturally there will be an added burden on the managers time, reducing his span of control. (g) Amount of personal contact required : Under many circumstances, face to face meetings or conferences with subordinates are essential, which draw upon the time of a manager resulting in narrower span of control. The concept of line and staff relationships : Traditionally, it has been held that line functions & personnel are those that are directly responsible for achieving an organizations primary objectives, while staff functions and personnel are those that assist line managers to function more effectively. Conceptually, it is important to note that in line relationship, there is a direct relationship of command between superior and subordinate, whereas staff functions are advisory nature to line managers whom they support. It is essential for any medical manager to know in what capacity (for example, an orthopedic consultant to a tertiary care hospital) their job is to advise and not

command, but when in line capacity (such as a medical superintendent of a large government hospital), they must make decisions and issue instructions for others to follow. Line organization : A line organization consists of line personnel, where each position has direct authority over all lower positions. No subordinate is under more than one superior, and the scalar principle and principle of unity of command are strictly adhered to. The flow of authority in line organisation is depicted in Box - 2.

Line and staff organization : When in addition to the line authority of managers, there are specialists and experts to advise various levels on specialized issues, it is called the line and staff organization . In the figure below, A, C and D managers are in direct line relationship as discussed earlier; but B is in staff relationship and advises A and C on important issues. B may have lower status than A and higher status than C in the organization, but is not in direct line of command. Generally in any organization, those personnel who develop new ideas, undertake research and advise on technical matters and fall outside the direct chain of command are staff personnel. It is important to remember however that even in a staff department (for example, finance department of a large corporate hospital), the departmental head would still have line control over all subordinate financial experts. The flow of authority in line and staff organization is depicted in Fig. 3.

Functional organization : In the large and complex organizations of the present day, the traditional principle of one boss and one subordinate (unity of command) is not possible. In such organizations, different superiors performing different functions (finance, human resource, inventory control etc) exercise control over a subordinate in respect of their respective functions. Thus a functional organization is one wherein a worker is accountable to two or more different executives for a given specific and specialized function. For example a radiographer in a large corporate hospital may be providing specialized services (radiotherapy) in three different wards and thus would be accountable or advising their respective Medical Officers incharge in addition to being accountable to the Head of Department of Radiology Services. The advantages and disadvantages are as in Box - 4.

The Matrix Organisation : A combination of the product and functional structures, the matrix structures are the choice for large and complicated projects where the skills of a functional man (manager) and specialized (technical) knowledge (e.g. finance consultant) are both required.

Under the matrix structure, an employee is accountable & takes orders from two different superiors at the same time. For example, a ward nurse is accountable to the Head Nurse of the Hospital as well as to the ward MO in which she is working. An example of the matrix organization in a large hospital is as represented in Box - 5.

Directing (Leading) Leadership can be described as the activity of influencing people to strive willinglyto achieve the group objectives. This ability may be formal(as in form of formal authority vested with an individual) or informal (as in form of power and ability to influence people outside the formal structure of an organization). Leadership styles : This refers to the way in which a leader would influence the followers. Some of the leadership styles are described below : (a) Iowa leadership studies : Lewin, Lippitt and White, in 1939, studied different styles of leadership among 10 year old boys in three groups. Three main types of leadership which emerged from their studies were : (i) Authoritarian leader : Where the leader was directive and did not permit any participation from team members. Concern for completing the task was of prime importance and each member of the team was told what to do and how to do. (ii) Democratic leader : One who encouraged participation and discussions by group members, he involved all group members in planning and completing the task. (iii) Laissez-faire leader : Such a leader give complete freedom to the group members, did not provide any leadership, did not establish policies or procedures to complete the job. Under such scenario, no member of the group influenced another member. (b) The Managerial Grid Theory The Managerial Grid Theory proposed by Black and Mouton in 1978 indicates that leaders can be oriented towards both tasks and persons. The managerial grid, based on the interaction between person-orientation and task orientation of a leader, is depicted in Box - 6 : The Managerial Grid shown here is characterized by the following qualities among the leaders : The (9, 1) leader is only concerned with task and has least concern for welfare of his subordinates. Such a leader is called a task-management leader.

The (1, 9) leader, called the Country Club management leader, is only concerned with people, to establish good relationship with and among his subordinates such leaders has least concern for tasks. The (1, 1) leader (impoverished leader) is neither concerned with welfare of his subordinates nor with the task. Such a leader does not take any decision and stays out of the way. The (9, 9) leader (Team Management leader) has maximum concern both for people and for task. Though an ideal situation, such a leader wants to achieve the goals through committed people. The (5, 5) leader (middle-of-the-road leader) attempts to compromise between high production and satisfaction of the subordinates.

Summary Management is the art of getting things done through and with people in formally organized groups. It is the art of creating the environment in which people can perform and individuals can cooperate towards attainment of organisational goals. It is the art of removing blocks to such performance and a way of optimizing efficiency in reaching goals. It is a process consisting of planning, organizing, actuating and controlling, performed to determine and accomplish stated objectives, by the use of resources like men, material, machines, methods, money and markets. The basic principles of management are Division of work according to the ability, capacity and aptitude of the workers; Well-defined responsibility; Discipline; Orders only from one superior; Preference of Organisational goals to individual goals; Pre-determination of remuneration in form of pay and allowances for all personnel; Centralization of important policy decisions and key matters; Functioning in well defined functional chain of senior-subordinate relationships (scalar chains); Unity of direction; Equity; Stability of working period (tenure); Initiative among employees; and the Team spirit. Administration can be defined as those functions in an organisation, which are concerned with policy formulation, finance, production, distribution and ultimately control all key activities

for meeting the organisational objectives. It can thus be assumed that policy-making, planning and decision making are the basic components of administration whereas supervision, implementation and operational aspects are considered components of management. To successfully attain the objectives with optimum resources, requires a series of Managerial processes which are Planning, Organising, Staffing & directing, Decision making, Controlling and Feedback. Planning is the fundamental and initial process in any activity. Setting the objectives is a major function of planning. The basics of planning process in the health sector consists of deciding Where are we at present (situational analysis), Where do we finally want to reach (objectives & goals), How do we get there (resources & constraints), How effectively we have performed the required activities (evaluation, monitoring & feedback), what new problems do we face and how do we overcome them (re- planning). Various types of plans can be classified as Mission of an organization (described as the very reason why that organization exists), Strategy (any decision, plan or action which takes into consideration the actions of competitors and other factors in external environment, with the aim of achieving the objectives), Policies (guide to decisions), Rules (guides to action), Procedures (chronological steps involved in performing any action or taking any decision), Program (a series of actions performed for achieving the organizational objectives within the scheduled time). As a function of management, organizing deals with identifying and grouping various activities, delegating authority and command to managers, and coordination of various activities and hierarchies in the organization. The process of organizing can be described as a series of steps which include Detailed description of various activities to be performed for achieving organizational goals, Grouping of various activities in some meaningful manner, Delegation (comprising of authority, responsibility and accountability), and Coordination (horizontal and vertical). Some important principles of organizing are Unity of direction, Unity of command, Authority, Span of control, Flexibility, Management by exception and Scalar principle. Depending on the type of organization and objectives to be achieved, every manager must decide how many subordinates he/she can effectively supervise. Consequently, a wider span of control will result in lesser levels of management. Seven important factors which determine the frequency and duration of superiorsubordinate interaction are Training levels of subordinates, Clear delegation of authority, Clarity of plans, Objectivity in standards, Rate of organizational change, Communication techniques and amount of personal contact required.In line and staff relationship, there is a direct relationship of command between superior and subordinate, whereas staff functions are advisory nature to line managers whom they support. A line organization consists of line personnel, where each position has direct authority over all lower positions. No subordinate is under more than one superior, and the scalar principle and principle of unity of command are strictly adhered to. A functional organization is one wherein a worker is accountable to two or more different executives for a given specific and specialized function. A

combination of the product and functional structures, the matrix structures are the choice for large and complicated projects where the skills of a functional man (manager) and specialized (technical) knowledge (e.g. finance consultant) are both required. Under the matrix structure, an employee is accountable & takes orders from two different superiors at the same time. Leadership can be described as the activity of influencing people to strive willingly to achieve the group objectives. This ability may be formal (as in form of formal authority vested with an individual) or informal (as in form of power and ability to influence people outside the formal structure of an organization).