Salisbury VA Hospital

Diagram the formal structure of your organization. Identify the various management
positions or titles on the chart and indicate the positions/jobs that would report to each.
Identify the various management positions or titles on the chart and indicate the
positions/jobs that would report to each. (attached paper)

  1. Describe how work is divided (specialization and departmentalization), coordinated
    (chain of command and span of control), and controlled (centralization and formalization).
    Is the structure more mechanistic or organic?
  2. Describe the informal structure of the organization. How does work actually get done?
  3. How does the organization deal with the differentiation-integration issue?
  4. Having completed this analysis, identify three strengths and three weaknesses of the
    organizational design.
  5. If you could suggest one major improvement to the organizational design, what would it

Organizational Design: The Case of Salisbury VA Hospital

Organization structure is important for any organization that needs to achieve success.
The structure does indicate the procedures and structures to be followed when addressing various
matters in the firm. An organization design refers to a formal strategy adopted by an organization
to ensure there is a seamless flow of communication from the higher levels of management to the
employees at the low-level positions. The departments are intertwined based on the operations,
and this does ensure that there is a flow of communication. The managers take the helm to ensure
that the operations of the organization are run smoothly (Foss, Lyngsie and Zahra, 2013).
The organizational design hierarchy does indicate the roles and responsibilities to be
carried out by the employees. In an organization where the employees do not understand the
organization structure, it leads to confusion, which hinders the effective operations of various
activities. As a result, it is pertinent to institute a chain of command that will guide the
employees on how to carry out their day-to-day operations. The top management makes the

decisions in the organization, but the departmental heads play a vital role in ensuring their
implementation. Therefore, the design does make sure that the organization will be able to
facilitate the internal and external growth of the organization based on its objectives (Foss et al.,
In the case of Salisbury VA hospital, it is a healthcare institution with a high-performance
index in California compared to other centers. That is due to its formal organizational design that
is in a recommendable style. Healthcare institutions are one of the crucial working environments
that demand a higher degree of confidentiality. That is because of the legal requirement of all
patients’ information as well as credentials blocked from exposure. Hence, a clear organization
design has to be used to make things go as planned. Additionally, the fact that hospitals are
highly populated also drives the need for a stable organizational design. They are institutions that
record employees’ turnover regularly increasing the number of operations each day. Below is a
diagrammatic representation of the Salisbury VA hospital organizational design (About the W.G

  • Bill Hefner VA Medical Center-Salisbury, NC, 2017).


Salisbury, NC VA director

Salisbury, NC VA Chief of Staff

Salisbury, NC VA Department
Chief of Radiology

Salisbury, NC VA Assistant
Chief of Radiology

Imaging Supervisor Diagnostic




Imaging Supervisor Computed

CT technologistCT technologist

The above sketching represents an organization design that shows how Salisbury VA
hospital is managed from the directors’ level to the departments. Different job titles have their
roles as indicated in the job description during the recruiting process. To begin with the hospital
director. It is a post that many people relate to high salaries and fewer tasks, which are not the
case. The director has a huge obligation to connect the internal and external stakeholders.

A good relationship has to be created to maintain the transparent working interface
between stakeholders. The director is also involved in decision-making processes. When
evaluation and analysis are done, result arrived to help the director and other managing personnel
come up with real decisions that act as a solution to the problem. Being the top most person in
the organization, it means the person is liable for any drop or rise in performance of the firm.
Therefore, it can be considered as one of the toughest posts in an organization (Schein, 2010).
In the chain of leadership, the chief of staff is the second in command whose main job
deals with managing the affairs of the employees. The activities of the chief of staff are linked to
those of the managing director whereby they work together to achieve the goals of the
department. The chief of staff also does provide advice to the managing director concerning
assigning employees different positions in the firm. In some organizations, the human resource
manager is tasked with the responsibility of handling the described tasks (Schein, 2010). Under
the chief of staff, a department chief of radiology is positioned together with that of the assistant.
Salisbury VA being a healthcare institution, such posts are essential as they deal with people
therapies and operations that require radioactive technology. Chief Radiology has to make
decisions in the department and delegate some tasks to the assistant (About the W.G – Bill
Hefner VA Medical Center-Salisbury, NC, 2017).
The next level of management includes imaging supervisor both radiology and
tomography. Their tasks are parallel to each other since they have same obligations though in
different departments. They have to oversee all the operations conducted in the radiology as well
as tomography room in the hospital. They give directions and instructions to team leaders when
necessary to ensure efficiency in their respective departments (About the W.G – Bill Hefner VA
Medical Center-Salisbury, NC, 2017).

At the bottom most level of the design lays the technologists who operate the machines
and implement the decisions. Having received instructions from the supervisor, technologists do
their best to ensure the decisions are implemented. Though they are classified as the last in the
design, they are the people with the right skills to operate the machines and make the company
productive. Their input in the company is high and demanding since they conduct the core
business of the organization (About the W.G – Bill Hefner VA Medical Center-Salisbury, NC,
Decentralization is not emphasized in the organization structure of Salisbury Hospital
since management power is only delegated to the radiology section. An organization has
numerous departments necessary for its daily operations. Therefore, it requires proper
distribution of the roles to ensure quality services are provided. Undermining a section may lead
to inconveniences that slow the rate of production (Leih, Linden, and Teece, 2014). For example,
procurement is a core business in the line of health due to purchasing of medicine and clinical
materials. However, Salisbury organization design does not recognize independent management
of the department. People who are good in radiology cannot be best in procuring. Therefore,
there is need to eliminate centralization and embrace decentralization in organizational design.
At Salisbury VA hospital the downward chain of command is used from the directors to
the technologists in the hospital. The chief of staff reports to the directors of the operations
taking place in the hospital. The briefing takes place after every fortnight, but in case of
emergency situations in the hospital, it takes place on a daily basis. Change in the organization
requires the approval of the directors after consultation with the supervisors and departmental
managers. The chief of staff steps in after decisions have been made to oversee their

implementation at various levels of the hospital (About the W.G – Bill Hefner VA Medical
Center-Salisbury, NC, 2017).
After planning and budgeting are completed, execution takes place at the supervisors’
level. Both radiology and tomography supervisors have to share the idea with technologists to
ensure that the project is successful. They enhance a smooth running of the hospital with or
without the presence of the director and the chief managers. At the lower level, working as a
team is the most crucial thing to maintain uniformity and accuracy (About the W.G – Bill Hefner
VA Medical Center-Salisbury, NC, 2017).
Salisbury VA hospital organizational design has strengths and weaknesses that define its
performance. The major problem is the centralization of power in the radiology sector, which is
the major activity in the hospital. Other minor departments ought to be given a chance of
presenting their input to the organization. Secondly, the company has few top officers at the
hierarchy involved in the decision-making process (About the W.G – Bill Hefner VA Medical
Center-Salisbury, NC, 2017). This leads to poorly informed decisions, which may affect the
growth of the hospital. Increasing top management personnel means that a lot of ideas will be
tabled before reaching the final decision. Such a system gives room for improvement and
reduces inaccuracy in the organization (Schein, 2010).
On the other hand, the organization design can be recommended for its short and
composed structure, which minimizes the chances of miscommunication. The levels are few and
interaction between the leaders and employees is enhanced. Supervisors have an easy time
working with all the technologists to ensure the implementation of the ideas generated at the
management level. Information coming from the director and the chief of staff reaches the
employees on a timely basis without delays. There is also the fact that decentralization equates to

reliability. Though there might be a high degree of inaccuracy, few decision makers speed up the
process hence increasing reliability (About the W.G – Bill Hefner VA Medical Center-Salisbury,
NC, 2017).
In conclusion, Salisbury VA hospital needs to have multiple top management officers to
eliminate centralization of tasks and decisions made by the director. An organization design may
have two or three lines of management, which are, integrated at the departmental or even the
bottom most level. Enhanced communication and reliability are the most important aspects of the
organizational design structure. Employees should work as a team to meet the organizational
objectives and long-term goals.


Reference List

About the W.G – Bill Hefner VA Medical Center-Salisbury, NC, (2017).

Foss, N. J., Lyngsie, J., & Zahra, S. A. (2013). The role of external knowledge sources and
organizational design in the process of opportunity exploitation. Strategic Management
Journal, 34(12), 1453-1471.
Leih, S., Linden, G., & Teece, D. (2014). Business model innovation and organizational design: a
dynamic capabilities perspective.
Schein, E. H. (2010). Organizational culture and leadership (Vol. 2). John Wiley & Sons.