Work Process Versus The Organizational Chart

In Jim Shaw's book, "Customer-Inspired^® Quality - Looking Backward Through the Telescope", he describes how many organization know that their efforts to improve their operations is not working but do not know how to address the situation.

"Many people think of an organization in terms of its hierarchical organizational chart. But an organizational chart describes the chain of command, not the work processes. The organizational chart is constructed vertically; work flows through the organization in a more horizontal fashion. Because the organizational chart depicts power and control, not how work gets done, it is of little use in improving processes. It can even get in the way, creating barriers and territorial disputes. Executives sometimes tend to adjust the organizational chart rather than improve their work processes.

"Managing horizontally means focusing on a process and its outputs to the customer instead of on a department and its reporting structure. Managing horizontally means recognizing the interdependencies of processes and avoiding the parochial, fragmented approach depicted in the organizational chart. Managing horizontally means taking the broad perspective and keeping the customer clearly in view."

Organizational Chart

Figure 1: The Organizational Chart from the Patient's Point of View

Typical List of Hospital Key Processes From a Patient's Perspective

Key Process	Improvement Priority High/Medium/Low
Provide and Manage Inpatient Care
Admit/Place Inpatients (Direct/Prescheduled) Prescheduled)
Admit/Place ED Inpatients
Discharge Patients
Manage Inpatient Care: Medical/Surgical Care
Manage Inpatient Care: Intensive/Critical Care
Manage Inpatient Care: Perinatal/Obstetrical Care
Manage Inpatient Care: Psychiatric Care
Manage Inpatient Care: Rehabilitation/SNF Care
Manage Patient Medical Information
Provide And Manage Standards for Care
Provide Diagnostic Support (e.g., X-ray) lab)
Provide Hotel Services
Provide Inpatient Scheduling
Provide Surgical Support
Provide Therapeutic Support (e.g., drug/RX) respiratory)
Provide and Manage Ambulatory Care
Provide Home Health Care
Provide Same Day Noninvasive Diagnostic Services
Provide Outpatient Rehabilitative/Therapeutic Care
Provide and Manage Clinic Care
Provide Same Day Surgery Procedure Services
Provide and Manage Emergency/Urgent Care
Manage Customer Complaints
Manage Patient Complaints
Manage Physician Complaints
Improve Revenue Cycle Processes
Provide Community Health Services/Education
Provide Information on Service Availability and Cost
Provide Support Processes
Evaluate and Improve Performance
Ensure Compliance with Regulatory Requirements
Manage Payer Contracts and Relations
Manage Risk and Safety
Manage Human Resources
Manage Information Systems
Obtain and Manage Supplies/Facilities/Equipment
Plan the Future

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Work Process Versus The Organizational Chart

Organizational Chart

Typical List of Hospital Key Processes From a Patient's Perspective

Key Process

Improvement Priority

High/Medium/Low

Provide and Manage Inpatient Care

Provide and Manage Ambulatory Care

Provide and Manage Emergency/Urgent Care

Manage Customer Complaints

Improve Revenue Cycle Processes

Provide Community Health Services/Education

Provide Information on Service Availability and Cost

Provide Support Processes