1. Identify and explain TWO 'structural dilemmas' that Beth Israel Hospital was attempting to address or rebalance through its restructuring process. Please first DEFINE/DESCRIBE each of your chosen structural dilemmas before applying it to the example from the case (Note: refer to hardcopy textbook pages 70-73 for the different structural dilemmas). When applying to the structural dilemmas, make sure that you reference examples from the case to show how these dilemmas are illustrated/what they look like in practical terms. 2. What were the consequences of the restructuring effort? Do you believe the new structure aligned with the organization's goals? Why or why not? Please fully explain. Beth Israel Hospital Boston's Beth Israel Hospital illustrates a health care restructuring effort that sought to move toward greater autonomy and teamwork. When Joyce Clifford became Beth Israel's director of nursing, she found a top-down pyramid common in many hospitals: The nursing aides, who had the least preparation, had the most contact with the patients. But they had no authority of any kind. They had to go to their supervisor to ask if a patient could have an aspirin. The supervisor would then ask the head nurse, who would then ask a doctor. The doctor would ask how long the patient had been in pain. Of course, the head nurse had absolutely no idea, so she'd have to track down the aide to ask her, and then relay that information back to the doctor. It was ridiculous, a ludicrous and dissatisfying situation, and one in which it was impossible for the nurse to feel any satisfaction at all. The system was hierarchical, fragmented, impersonal, and (overmanaged] [Helgesen, 1995, p. 134) Within units, responsibilities of nurses were highly specialized: some were assigned to handling medications, others to monitoring vital signs, still others to taking blood pressure readings. Add to the list specialized housekeeping roles-bedpan, bed making, and food services. A patient received repeated interruptions from virtual strangers. No one really knew what was going on with any individual patient. Clifford instituted a major structural revamp, changing a pyramid with nurses at the bottom to an inclusive web with nurses at the center. The concept, called primary nursing, places each patient in the charge of a primary nurse. The nurse takes information upon admission, develops a comprehensive care plan, assembles a team to provide round-the-clock care, and lets the family know what to expect. A nurse manager sets goals for the unit, deals with budget and administrative matters, and makes sure that primary nurses have ample resources to provide quality care. As the primary nurses assumed more responsibility, connections with physicians and other hospital workers needed reworking. Instead of simply carrying out physicians' orders, primary nurses became professional partners, attending rounds and participating as equals in treatment decisions. Housekeepers reported to primary nurses rather than to housekeeping supervisors. Housekeepers assigned to specific patients made the patient's bed, attended to the patient's hygiene, and delivered food trays Laundry workers brought in clean items on demand rather than making a once-a-day delivery. Sophisticated technology gave all personnel easy access to patient information and administrative data. Primary nurses learned from performing a variety of heretofore menial tasks. Bed making, for example, became an opportunity to evaluate a patient's condition and assess how well treatment plan was working. Joyce Clifford's role also transformed, from top-down supervisor to web-centered coordinator: "A big part of my job is to keep nurses informed on a regular basis of what's going on out there-what the board is doing what decisions are confronting the hospital as a whole, what the issues are in health care in this country. I also let them know that I'm trying to represent what the nurses here are doing-to our vice-presidents, to our board, and people in the outside world... to the nursing profession and the health care field as a whole (Helgesen, 1995. D. 1981 Beth Israel's primary nursing concept, initiated in the mid-1970s, produced significant Improvement in both patient care and nursing morale Nursing turnover declined dramatically Springer, 1982), and the model's success made it highly influential and widely copied both in the United States and abroad. But even accessful change won't work forever. Over the years patients with more problem but shorter hospital says made sure jobs much harder at the approach by creating interdisciplinary care team stead of assembling an ad hoc collection provided interdisciplinary support to primary Randall Star weather, and Norrish, STRUCTURAL DILEMMAS Finding an apt system of roles and relationships is an ongoing, universal struggle Managers rarely face well-defined problems with clear-cut solutions. Instead, they confront enduring structural dilemmas, tough trade-offs without easy. Differentiation vers Integration The tension between assigning work and synchronising sundry efforts creates a desse dilemma, seen in Chapter Three. The more complex a role structure lots of people doing many different things, the harder it is to sustain a focused, tightly coupled enterprise. Think about the challenge facing Larry Summers as he tried to bring a higher level of coordination to a highly decentralised university. As complexity grows, organisations need more sophisticated and more costly coordination strategies. Lateral regles need to supplement top-down rules, policies, and commands Gap versus Overlap If y responsibilities are not clearly id, important tall through the cracks Conversely, roles and activities can overlap, creating conflict, wasted effort, and unintended redundancy. A patient in a prestigious teaching hospital, for example, called husband and pleaded with him to e her. She couldn't sleep at night because hospital staff lept waking here to repeat procedure or administer a medication that someone else had done a short time before Comedy, when she wanted something, pressing her call button rarely produced any response The new cabinet-level Department of Homeland Security, created in the wake of the terrorist attacks, was nended to reduce saps and overlaps among the many species responsible for responding to domestic threats Activities incorporated into the new department included Immigration, border protection, emergency management, and intelligence analysis. Yet the two most prominent terrorism agencies, the land the CIA- with their long history of mutual sa overlaps, and bureaucratic squabbling-remained separate and outside the new any (Firestone, 2009) Underver Overload If employees have to work, they become bed and get in other people's way Members of the derical in a physician's offee were able to complete most of their tasks during the main After lunch, they led the time being to family and friends. As a result, the telephone Tines were constantly by making it difficult for patients to sto schedule Appointments Mem, dients and routine paperwork wamped the nurses, who were brandenben they were so busy. Patients complained about impersonal care Resiging many of the serialities to office staff created a better structural balance Lack of Clarity Lack of Creativity If employees are underhout what they are supposed to do they often their roles of personal perferences in of shaping them to meet ytte goals. This frequently leads to Grohe Most MeDonald's are not seeking novelty and surprise in thelburgers and fries But when replace and people conform to prescribed roles and process "bure ways. They yellow job description regardless of how much the service or You lost my ban ng page should confronting an ima Excel Autonomie laterependence If the efforts of individuals or groups are open Schaden may feel lonely and reported because they work in self-contained and many other adults. Yet efforts to create closer to be repeatedly power difficulties in working together. In contrast, ito y come people in roles and distracted and spend too much time on the personal computer business in part because we are so many peo and divisions like that products were verdeeld late to market. 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