N108: Transition to the Registered Professional Nurse Role Study Guide 3.6 The Nurse in the Health Car Organization Mission, Philosophy, and Goals The purpose of an organization is often expressed in the form of a mission statement, which outlines what the organization plans to accomplish, including its goals and function. Sometimes, mission statements incorporate statements of philosophy (beliefs) and goals or objectives into a single statement; other times, the philosophy and goals are addressed in a statement separate from the mission statement. The mission of an organization may be combined with a vision, which is a broad conceptual view of what the organization desires to be and do. Mission and vision statements serve as standards against which an organization’s performance can be evaluated. Organizational Structure A central goal of most organizations is to seek an organizational structure that is efficient while providing maximum cost effectiveness. The structure of an organization outlines the formal working relationships and identifies who is accountable and responsible for various jobs required within the organization. The structure reflects the manner and extent to which roles, responsibilities, and power are delegated, controlled, and coordinated and how communication occurs between levels of management. The power to make decisions is a key factor in the structure and function of any organization. Organizations may be described as having a centralized or a decentralized structure. • Centralized (tall): The authority to make decisions is vested in a few individuals in the top layer of management. For example, in the patient services area of a hospital, major decisions may be made by the vice president of patient care and two or three associates. • Decentralized (flat): This is when the decision making involves a number of individuals and individual employees are responsible for making decisions in areas in which they have expertise. Major decision making is distributed and decisions may be made by the individual closest to the action, as in a head nurse or unit manager may be responsible for more than one patient care unit. • Matrix structure: This may be either flat or tall and is also referred to as cross-functional. The unique characteristic of a matrix structure is that a second structure overlies the first, creating two directions for lines of authority, accountability, and communication. An organization will have an underlying structure (either tall or flat) that is a functional structure over which is imposed a project structure. In short, the individuals in the functional structure perform the duties of operating and maintaining the organization, and the individuals in the project structure oversee the application of various projects and special responsibilities. This type of structure is typically seen in large, multifaceted organizations. Authority and Responsibility When examining organizational function, it is important to identify relationships among people and departments and realize where the authority and responsibility are placed within that organization. Authority means that the individual has the power or right to take action, give directions or commands, and make final decisions. Accountability is being obligated to answer for one’s actions and sometimes, as when certain tasks are delegated, for the actions of others often referred to as responsibility. A synonym frequently used for accountability is responsibility.