Anersley Hospital is one of the many organisations facing a tough future due to the change in work patterns. The case study illustrates the importance of better management and positive attitude of the employees towards the organisation. Here the main issue is the change in working practices and the effect it has on the people involved and the overall organisational goals. It can be said that the Medical Records Department at Anersley Hospital functioned under few metaphors namely 1) Organisations as Machines 2) Organisations as Organisms 3) Organisation as Political Systems 4) Organisations as Psychic Prisons.
Below is a detailed analysis of the Anersley Hospital case study with reference to the above mentioned metaphors. Analysis Before the Move It can be clearly seen from the case study that “Shack”, the old medical record department, worked very efficiently and the people had a positive attitude towards achieving the departmental goal without the implementation of any major business or management theories.
Mrs. Price the records manager had a very close working relationship with her staff which made her staff feel counted and it felt to them that their presence made a great difference in the “Shack”. The whole structure was based on teamwork and
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Although the working conditions were not up to the standards such as desks and equipment of the medical records filing section which were worn out, and the actual racks and shelves for the storage of patient’s records were a selection of miscellaneous designs and of various ages that had just accumulated over the years, the workers in the department were allowed to put up coloured posters and cartoons to make the place more cheerful and give touches of homeliness and individuality. The kind of policy allowed for a relaxed working environment in turn leading to a positive working attitude of her staff.
“For most people work is a place to socialise, and complex social systems develop within the work place which often spill over into leisure time” (Noon & Blyton, 2002, 77) The staff appeared to manage their operations in an organic way and formed an integrated sub-system of a larger medical records system. This is characterized by the nature of contribution of expertise and knowledge within the “shack” to the common task of dealing efficiently with collection and return of patient medical records.
The commitment of the staff at the “Shack” could also be seen in there willingness to work beyond their technical job specification. The “Shack” personnel occasionally performed the task of appointments clerks and reciprocally appointments clerks searched for the records that they need. These actions suggest that the corporation level between the systems (sub systems and larger system) was very high, and the communication flow was lateral rather than vertical through the system.
The “Shack” system clearly demonstrates Morgan’s diagram of interdependent systems, as the boundary spanning activities of related systems which characterize an organic structure. It is apparent from the case study that Medical Records of Anersley Hospital office operated openness. ‘According to Taylor, the only motivation for the worker was the money (Makin, Cooper & Cox, 1989, 32-65), in order words to full fill the fundamental needs as described in Maslow’s hierarchy of needs (Huczynski & Buchanan, 2001, 240-243).
However, as many theories of motivation suggests, the human being is driven by more things than just food, housing and material status, the so called extrinsic values. Other values are as important, namely elements such as job satisfaction, the sense of accomplishment, being able to identify oneself with the product one is making and the feeling of making a difference.
These are a part of the intrinsic values (Rosenfeld & Wilson, 2000, 95). ‘ After the Move Arrival of Mr. Fraser leads to sudden changes in the system such as new clinic building, new equipment and new staff appointments. The old employees were not given enough time to adjust to the new changes. This change possibly trigged the breaking-up of the mature sub-systems that worked efficiently and formed a social group characterized by, for example the doughnut scheme. However it is evident that communication through the entire department and with Mr. Fraser was extremely limited, this can be illustrated by way in which he acquainted the staff with the new system.
Mr. Fraser spent a considerable amount of time with the O & M team and the Architect’s Department at the regional headquarters from where he devised work instructions for each member of the staff to follow. He then gave Mrs. Price a short briefing, and entrusted her with the task of instructing her staff. It is clear from Mr. Fraser actions that he wished to implement a mechanistic system, more generally known as either “classical management theory” or a “scientific management” which was first defined by the German sociologist Max Webber.
His plan incorporated a pattern of precisely defined jobs organized in a hierarchical manner through precisely defined line on commands. The medical records staff may have “perceived” that under the new scheme they would have little responsibility and/or opportunity for achievement and recognition of their worth, because there was insufficient delegation of decision-making process. Such concerns are usually expressed in an increase in gossip and a decrease in work efficiency and effectiveness.
Further more Mr. Fraser did not understand the gravity of the situation when he was confronted with the passivity of the staff at the “Shack” and when they did not ask him any questions on his detailed instruction about the new system. The operation of the new medical records system can be described as mechanistic in nature. The diagram showing the new layout gives a clue to this mechanistic system. Each department was now separated from the other by opaque glass screens, and where the filing clerks worked in a imprisoned or in other words physic prison (the physic prison metaphor), behind a glass screen with the exit barred by a sliding door.
Further the working behaviour of staff was monitored and governed by Superiors, Records Administrator and the Records Officer, evidenced by stopping the doughnut scheme, hanging of pictures on screens and the defined and limited time during which staff could leave the office. To each task there is attached a specific and precisely defined set of instructions on how the task should be carried out and further instructions that tasks are solely the obligation of those entrusted them.
Each task can be said to be of an abstract nature that is pursued with technique and purpose more or less distinct from those of the medical records as a whole. This precise and hierarchical control over individual’s tasks is reinforced by Fraser’s insistence that task to task problems are dealt with by vertical communication, that is, between superior and subordinate. Thus the location of knowledge of the operation of medical records as a whole resided exclusively at the top of the hierarchy where it was controlled.
This differentiation of tasks was a characteristic of a mechanistic system. Thus it appears that the medical records department had become a hierarchical and mechanistic structure of control, authority and communication. In my view Mr. Fraser implemented the hierarchical structure because he assumed that the group needed some form of leadership to resolve its predicament. The result of this new authoritative structure meant that the group’s attention was split from the problems at hand and were projected onto a particular individual.