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General Outline of the case:

Joan Porely is a general manager of an eye hospital based in UK and Dr. Iris Glass is the senior eye surgeon
of the same. They want to find out the best practices used in surgical procedures and usage of latest
technology. Along with this they also aim to find out the best possible organization structure which can be
used in a hospital to ease the work and earn more profits. They visit St. Petersburg Research Institute run by
Dr. Fyodr Sviatorov, an eye hospital which has pioneered the use of eye surgery to correct eye defects.
They interviewed Doctor Sviatorov and found out various aspects which he uses in his organization. The
technology used, staffing, who does what and the process of a laser eye surgery to cure short sightedness is
given. Ms. Joan and Dr. Glass draw conclusions about the organization structure.

We are asked to find:

1. Structural configurations and organizational goals.

2. Steps in decision making process of Leadership Style.

Organizational Structure:

Organizational Structure (OS) is the framework that defines formal reporting relationships between
different levels of management of an organization. Organizational Structure is the mechanism that checks
the operations in the management of the organization. In the context of a hospital, Organizational Structure
refers to the levels of management within the hospital. It defines the hospital’s chain of command. Large
hospitals have complex organizational structures. Hospital departments are grouped in order to promote
efficiency of facility. Grouping is generally done according to similarity of duties.

We know that Henri Mintzberg's theory of structural configurations holds that an organization can be
analyzed into several components which he presented in his book ‘The Structuring of Organizations and
Structure in designing effective organizations’ in the early 1980s.

Let us review each of these structures and then relate to Doctor Fyodr Sviatorov’s hospital.

The Mintzberg’s theory describes six valid organizational configurations:

1. Mutual adjustment: Coordination is achieved by simple process of informal communication as between
two colleagues.

2. Direct supervision: Coordination is achieved by when one person issue orders or instructions to several
others whose work interrelates, for example, the way a boss instructs his subordinates.

3. Standardized work processes: It achieves coordination by assigning the work processes of people
performing almost similar tasks.

4. Standardization of outputs: Coordination is by specifying the results of different tasks. For example
Finance department of an organization may be expected to take salary reports of employees in a specific

5. Standardization of skills: Coordination is achieved by the virtue the related training the employees
receive. For example, a cameraman working with director can easily relate his instructions to camera

6. Standardization of norms: This makes sure everyone functions according to the same set of beliefs and
guidelines. A simple example can be not using camera phones in the work area of an organization.

According to Mintzberg, organizations are formed of five main parts:

Operating Core (Operational Process)

It relates to those who perform the basic work which is related directly to the production of products and
services. Here the doctors carry out the initial diagnosis, who conducts the eye tests to see the deficiency
that needs to be corrected and to check for any other complaints. There is the anesthetist and a doctor who
cleans and dresses all the wounds and who administers necessary antibiotics.

Strategic Apex (Top Management)

It ensures that the organization serves its mission in an effective way, and also that it serve the needs of
those people who control or otherwise have power over the organization. Doctor Sviatorov set up the
hospital and has plans for its expansion. He is responsible for strategic decision making.

Middle Line (Middle Management)

It forms a chain joining the strategic apex to the operating core by the use of delegated formal authority.
Doctor Sviatorov employs senior surgeons to design the operation process.

Techno structure

They include analysts who serve the organization by affecting the work of others. They may design it, plan
it, change it, or train the people who do it, but they do not do it themselves. The speed of the conveyor belt,
the programming of the computer, the exact sequence of cuts to be made, etc are all determined in advance,
by technicians who have designed the safest and most economical sequence of movements.

Support Staff

Composed of specialized units that exist to provide support to the organization outside the operating work
flow, they provide ancillary functions, such as legal advice, public relations and similar advises. If Dr.
Sviatorov wants to expand in the West, he will need a good support staff to win over the approval of people
such as Doctor Glass, before such procedures are allowed to be imported by other countries.

Generic organization structures

Based on these parts, there are five generic organization structures which can be described in terms of the
five-part theory.

Simple Structure (Entrepreneurial Startup)

The simple structure, typically, has

• Little or no techno structure, few support staffers

• A loose division of labor, minimal differentiation among its units, and a small managerial hierarchy.
• The behavior of simple structure is not formalized and planning, training, and liaison devices are
minimally used in such structures

The hospital in the case does not go through the simple structure as although it has few support staff, it has
lot of techno structure. The structure is very much planned and organized and follows systematic steps to
carry on the tasks.

Professional Bureaucracy

The professional bureaucracy has the following features:

• The standardization of skills and its associated parameters such as design, training and
• In professional bureaucracy type structures duly trained and indoctrinated specialists -professionals-
are hired for the operating core, and then considerable control over their work is given to them.
• Most of the necessary coordination between the operating professionals is handled by the
standardization of skills and knowledge, especially by what they have learned is important in order
to expect the same from their colleagues.
The professional bureaucracy although applied in almost all the organizations cannot be suited here as Dr.
Sviatorov is continuously seeking measures of reducing manpower and increase his profits. If he employs
excessively trained and well qualified doctors in his hospital they will demand a heavy salary and there are
chances that they quit any time. So the efforts spent on further training them would be a waste and the
search for equally or more qualified people would start all over again.

Divisional Form

Also called a "product structure", the divisional structure groups each organizational function into
divisions. Each division within a divisional structure contains all the necessary resources and functions
within it. Divisional structure divides the employees based on the product/customer segment/geographical
location. For example company that produces three distinct products, "product a", "product b", and "product
c". This company would have a separate division for each product.

The features would be:

• Horizontally diversified products or services

• In a straight-forward, stable environment
• Where large economies of scale need not apply.

This structure allows for flexibility and quick response to environmental changes. It also enhances
innovation and differential strategies. But as far as any hospital is concerned we cannot adapt this kind of
structure as a hospital has no varied brands and products to offer.

Adhocracy (Innovative Organization)

Adhocracy includes a highly organic structure, with:

• Little formalization of behavior.

• Job specialization based on formal training.
• A dependence on liaison services to encourage mutual adjustment which is the key
coordinating mechanism within and between these teams

Managers such as functional managers, integrating managers, project managers etc. abound in the
adhocracy type structures. Project managers are particularly numerous, since the project teams must be
small to encourage mutual adjustment among their members, and each team needs a designated leader, a

The innovative organization cannot rely on any form of standardization for coordination and therefore
cannot be applicable to the hospital. The eye surgery follows a standard operating procedure to do the task.

Machine Bureaucracy

The design of a machine bureaucracy tends to be as follows:

• Highly specialized, routine operating tasks.

• Very formalized procedures in the operating core.
• A set of rules, regulations & communication.
• Large-sized units at the operating level.
• Relatively centralized power for decision making.
• An elaborate administrative structure with sharp distinctions between line and staff.

The machine bureaucracy depends primarily on the standardization of its operating work processes for
coordination. The machine bureaucracies are typically found in the mature organizations, large enough to
have the volume of operating work needed for repetition and standardization, and old enough to have been
able to settle on the standards they wish to use. The managers at the strategic apex of these organizations
are mainly concerned with the fine-tuning of their bureaucratic machines.

This is quite an unusual configuration for to see in a hospital. It could not be generally applied, as most
hospital operations are more complex and the standard sequence followed for eye surgery cannot be applied
to all the surgeries. It looses individual initiative and professional judgment.

But this kind of organization is created to earn more profit with minimum efforts which is exactly what we
see in case of this hospital. It is highly automated and the techno structure emerges as the key part of the
structure. We see that from all the operations between anesthesias to dressing the wound are done by
machines. The fact that the procedures are standardized, which means they can be dealt by the machines.
To the extent that surgeons are replaced by robots. The operation even takes less time to perform which
saves time resource.

This hospital is an institute of eye microsurgery where the process is more standardized, thus the machine
bureaucracy can be applied. Ms. Joan Porely is impressed with such a concept as she wants to improve the
financial position of her hospital. If the number of machines is more than it could be a one time investment
except for few maintenance charges here and there. This would in return yield more profits for the hospital.

As we have seen that Machine Bureaucracy in case of this hospital, we now have to see the best
Leadership Style which could make the decision making process less complex.

There are several different approaches to being an effective boss or project leader. Some people are born
with a natural style and some can learn to mold their behavior to fit any situation. Earlier there was a saying
that leader are born. But now things are different. Leaders can be made. Understanding each style is
important in order to maximize your leadership skills.

Autocratic Leadership
This form of leadership is one of the least desirable when it comes to building trusting relationships. In a
system of autocratic leadership, one person has control over all of the workers or followers. The leader is in
complete control and no one is permitted to make any suggestions or offer any opinions, no matter how it
may benefit the group. But there is a time when autocratic traits can prove beneficial. This form of
leadership is effective when absolute control is needed over a group. Here the leader should be willing to
take charge, divide the work, and set deadlines. He or she must take full control.

You will find that autocratic leadership can make you very unpopular. If communication and trust are
important, you don’t want to lean too far toward autocratic leadership. If you consider a hospital, there is no
way you can apply Autocratic Leadership. The doctors are qualified and by no means shall they obey blind
instructions. They have the brains to take part in the decision making and if the organization does not allow
them to do so, they are free to quit the organization.

Democratic Leadership

Under democratic leadership, the people have a more participatory role in the decision making process. All
decisions are allowed by others to share insight and ideas. It involves voting on the best course of action in
a project, asking group members to work with their strengths and provide input on how to divide the work
and enabling members to work at their own pace and set their own deadlines.

This kind of leadership in professional organizations could lead to chaos as all the decisions, even key
decisions are taken by everyone. Here the decisions are taken on the consensus of opinion of the entire
group. It also takes lot of time. But there are some decisions in organizations like hospitals where decisions
need to be fast. Here credit is not given to any one individual.

Bureaucratic Leadership

Bureaucratic leaders work “by the book”, ensuring that their staff follow procedures exactly. This is a very
appropriate style for work involving serious safety risks such as working with machinery, with toxic
substances or at heights or where large sums of money are involved such as cash-handling.

Here the inflexibility and high levels of control exerted can demoralize staff, and can diminish the
organization's ability to react to changing external circumstances. Certainly cannot be used in a hospital
where one has to keep adapting to the new technologies.

Participative Leadership

Being a participative leader means involving team members in making decisions. This style involves the
leader including one or more employees in the decision making process determining what to do and how to
do it. However, the leader maintains the final decision making authority. Using this style is not a sign of
weakness; rather it is a sign of strength that your employees will respect. Along with the power to take
decisions it also gives rewards which may be in monitory or just recognitions among the team members.
Motivating employees who are knowledge workers is based on making them feel valued. There is simply
no better way to make people feel valued than to ask them, genuinely, for their advice. You can pat people
on the back and recognize their efforts but this is not as effective in motivating people as involving them in
important decisions. A leader is not expected to know everything -- this is why you employ knowledgeable
and skillful employees. Using this style is of mutual benefit -- it allows them to become part of the team
and allows you to make better decisions.

Being a participative leader means involving your team in making some, but not all, key decisions. This is
most essential when creative thinking is needed to solve complex problems. Much of a work in a hospital
has a high knowledge component that requires people to think and solve problems. The work is
increasingly mental work.

These were some of the decision making processes in the leadership style and we can say that the
Participative style suits the best for the hospital given in the case. Although they follow a machine
bureaucracy, the final decision making and implementation lies in the hands of the experts who are humans.