Report: Organisational Structure and Culture in the NHS, England

This report provides a comprehensive analysis of the organisational structure and culture within the National Health Service (NHS) in England. It begins by assessing the hierarchical structure of the NHS, outlining the roles and responsibilities of key figures such as the Board of Directors, Chief Executive, and various divisional directors. The report then contrasts the NHS's structure with other types of public sector organisational structures, such as hierarchical and flat structures. A significant portion of the report is dedicated to exploring organisational culture, its impact on employee behaviour, and the influence of government policies. It examines how local and central government policies affect the NHS, focusing on areas like promoting well-being, business conduct, and health and safety. The report also delves into the monitoring and accountability mechanisms within the NHS, including the relevance of chain of command, span of control, and line of authority. Furthermore, it discusses the distributive management style adopted by the NHS, emphasizing teamwork and shared values. The report concludes with an overview of organisational behaviour and its impact on workplace performance, motivation, and reflection.

Organisational Structure and
Culture

Table of Contents
INTRODUCTION...........................................................................................................................3
P1.Assessment of organisational structure..................................................................................3
P2.Different types of public sector organisational structure.......................................................6
Organisational culture, its role and influence on employee's behaviour.....................................6
P3.The impact and role of local government and central government policies on NHS............7
Monitoring and accountability in NHS ......................................................................................8
P4.Management style and approach in NHS...............................................................................9
P5.The concept of organisational behaviour.............................................................................10
P6.The impact of performance at the workplace in relation with motivation, organisational
behaviour and reflection............................................................................................................11
CONCLUSION..............................................................................................................................12
REFERENCES..............................................................................................................................13

INTRODUCTION
Organisational structure can be defined as the hierarchy followed in the organisation for
communicating, decision-making and its implementation, chain of command, span of control and
handling of grievances. Such structures helps in avoiding confusion among subordinates
regarding who will reports to whom. On the other organisational culture can be understood as the
working environment, policies, practices and procedures followed in the organisation by the
management. Both organisation culture and structure have its role in the conduct of
organisational affairs and success of the whole organisation. In this report we will be discussing
organisational culture and structure in the context of National Health Services, England.
P1.Assessment of organisational structure
National Health Services or NHS follows hierarchical organisational structure which has
large chain of command beginning from top till bottom level. It describes who is responsible for
management and who is accountable to whom. It also describes span of control which states that
how many people are effectively managed by a manager. Here we have an organisational
structure of NHS has been given which flows from top level that is, board of directors to bottom
level that is, different departments carrying out different activities.
Board of directors: On the top level of the organisation which is NHS, we have board of
directors which includes chairman, executive directors and non-executive directors. They are
responsible for devising strategy for public and its stakeholders welfare which ensures that their
health is in reliable hands (Ali Taha, Sirkova and Ferencova, 2016).
Chief Executive: The role of chief executive include assurance of the best quality to patients and
all the facilities are being delivered efficiently. They are also responsible for financial and
management related activities of the NHS. Now its duty has been extended with the clinical
governance introduction which also include the duty to follow clinical standards.
Associate medical directors: The key roles of this position includes devising clinical strategy
by taking into considerations the innovations in medical field and ensures the implementation of
the same. They are responsible for timely follow up on clinical standards and advice the board on
improvements in clinical facilities. They bridge gap between board and medical staff. There are

four divisions under Associate medical director, that is surgery and cancer division, division of
medicine and emergency care, women and children care and diagnostics and clinical support
services division (Bishwas and Sushil, 2020).
Divisional directors of estates and facilities: They are responsible for managing estates of the
NHS which includes ensuring good infrastructure, safe environment for patients and staff,
managing audit related activity and ensures that whatever improvements are demanded must be
followed. They are responsible also to fulfil the statutory requirements. They have one division
under them that is estates and facilities division to carry out its responsibilities.
Executive team: This is a team of various executives who are professional of different field
performing different activities for ensuring the management of NHS (Chandwaskar, 2019). This
include functions such as finance, HR, communications, service developments, learning and
development, governance, organisational developments and information management and
technology.

P2.Different types of public sector organisational structure
Organisational structure can be of many types depending upon the size and type (private or
public). There are basically two structures popularly followed by many public and private
organisations.
Hierarchical or vertical structure: This structure is majorly followed in governmental
organisation, nationalised companies and industries where communication takes place through
chain of command. Senior level or top level managers working at the top hierarchy undertakes
decision-making activities and devise strategy for the organisation (Collins, 2019).
Communication from both top to bottom and bottom to top can be done through proper chain of
command.
Flat or horizontal structure: This structure has managerial position at one level and have just one
level under it where communication can be done between divisions and departments without any
intervention of management. This structure allows for direct communication between
management and employees without any wastage of time.
Organisational culture, its role and influence on employee's behaviour
Organisational culture can be defined as the practices, beliefs, and attitude of the members of the
organisation in conducting their day to day activities. It varies from organisation to organisation
depending upon its size, type of control whether it is private or public, beliefs in the marketplace,
etc. (Felipe, Roldán and Leal-Rodríguez, 2017) Talking about the organisational structure in
public sector organisation, like NHS where various managerial reforms has been taken place in
modern times. Earlier bureaucratic culture has been followed now a lot of focus has been given
to implementing change in the area of flexibility, efficiency, productivity and employee
consideration. Such organisation are controlled and managed by governments at different levels,
so limited change in the culture in terms of control and flexibility has come up. Government and
its associated and authorised body usually takes all the major decision and controls the affairs of
the organisation. All the activities are monitored by governmental body as these public sector
organisations are funded by government or the major stake of the company is in the hand of
government. Generally less consideration has been given to individual performance and less
motivational tools are there for greater performance, as their emphasis is just to achieve the goal
of organisation and social development.
Role of organisational culture in influencing on employee's behaviour

Good brand image: With good organisational culture, the brand image can be enhanced which
helps in attracting good base of talented and potential employees.
Motivates employees: Friendly and flexible culture always motivates employees to perform well.
It helps in establishing good relations among employees and they will show loyalty to the
organisation (Kalaiarasi and Sethuram, 2017).
Emotional attachment: Employees become emotionally attached to the organisation and adopt
competitiveness in achieving its goals.
Optimism and clarity of thoughts: Employees will show positivity towards managerial directions
and instructions. They will be more informed of their responsibility and roles if the
organisational culture would allow a good communication between management and employees.
P3.The impact and role of local government and central government policies on NHS
Promoting well- being: As a public sector organisation their focus is always on well being of the
public. The government frames various policies in this regard to ensure proper healthcare
facilities for the public. The central government in response for tackling local needs has been
delegating more roles and responsibilities to local government so that more focus can be placed
on local population (Ullah, Badshah and Shaheen, 2017). This will ensure equality in provision
of healthcare services.
Policy of conducting business: This policy states the standards of business conduct and public
service quality which strengthen the work of NHS through guidance and practices which must be
followed by NHS' s staff.
Health and safety policy: Commitment towards health and safety and how NHS will be succeed
through better provision of health and safety has been reflected in this policy.
Corporate documents and management policy: This policy is all about creation of corporate
documents and records and its management, also how and where these documents are stored and
disposed off. This will ensure that no internal information would be leaked (Organizational
Culture, 2020).
All of the above mentioned policies are made for NHS where government from time to time
frames various policies for the provision of guidance and advice to the NHS staff. If there seems
to be some weakness in the system of delivering public services to public then government has

the right to take immediate decision and make changes in policies accordingly (Winkelhake,
2018).
These policies have major impact on the conduct of various activities, like more focused staff
towards delivering services to public, the policy related to charges applicable to patients helps in
avoiding inequalities among rich and poor. These public sector organisation's management are
accountable to government for their conduct, performance of the company, quality of services
and public satisfaction and well being.
Monitoring and accountability in NHS
Monitoring is the regular observation and assessment of performance by collecting and
analysing data. It helps in identifying the most valuable and efficient use of resource. There are
basically three elements of NHS monitoring such as it is a continuous process and because of this
it is also called process evaluation which runs through the entire program, regular collection of
data at frequent intervals and the intervals can be monthly, bi-monthly or quarterly and lastly the
identification of gaps in implementation (Bhatia. and Sood, 2016). There are various principles
for monitoring in NHS which means it should be focused, timely, usable, credible and ethical.
Accountability is the answer-ability or the blameworthiness of the performance undertaken. It is
taking the responsibility of the actions performed. Accountability in NHS teaches their
employees the value of their work and also this increases the skills and confidence of the team
members of NHS (Bearman. and Vokes, 2019).
Effective monitoring and accountability helps in ensuring effective management of public
resources. There are relevance of various components in monitoring and accountability such as:
Relevance of chain of command – Chain of command refers to the official hierarchy of
authority in NHS and clarifies the reporting relationship in the organization. As chain of
command clarifies which employee is responsible for which work or which doctor or nurse is
responsible for which patient this gives accountability on the part of NHS staff for task
performed by them. It is also convenience in monitoring the as the chain of command is clear
and does not change therefore the performance of workers employees at the post can be
evaluated and effective management of public resources are ensured.
Relevance of span of control – Span of control refers to the numbers of subordinates guided
under a superior. The superior can easily evaluate the performance of the subordinate placed

under it and also accountability will also be easier as groups are segregated and it ensures
effective management of public resources.
Relevance of line of authority – Line of authority is the power of superior to give orders or
instructions to their subordinate. Lien of authority helps NHS in monitoring and accountability as
instructions and orders are given to conduct the work therefore the subordinates does not perform
the work as per their convenience therefore monitoring can be done effectively and as orders are
given by the superior to specific subordinate therefore the superior has the knowledge about the
work performed by each subordinate therefore accountability is also easier to ensure effective
management of public resources.
Relevance of centralization or decentralization in monitoring and accountability – As NHS
is a public sector organization and there are number of people in it therefore for monitoring and
accountability decentralization approach is better to effectively manage the public resources.
P4.Management style and approach in NHS
NHS requires leaders and managers at different levels there fore the management style
and approach followed by NHS is distributive management style. It is based on the lead4ership
which helps in building the capacity and provide a room for change and improvement. It is
spreading the management and leadership across the organization for convenience and to
generate more opportunities. All the management activities are distributed across the
organization. One specific person is responsible for each task. In this style of management the
teamwork beats the hierarchy aspect (Günzel-Jensen, Jain. and Kjeldsen, 2018). It also allows
the staff to work across boundaries and it is build upon common tasks and shared values. This
approach creates a learning culture in the organization and strives for improvement. It is sharing
of leadership with different staff at different organizational level. NHS considers that distributive
management style is not an act but a mindset of the people in organization relating to operation
of the organization. It creates a positive relationship between the distributive management style
and the organizational improvement and also output of NHS is also enhanced. The management
and leadership model of NHS consist of inspiring shard purpose, leading with care, evaluating
information, connecting the services and sharing the vision. After sharing the vision efforts are
put to engage team and holding to account. The next things is to develop capabilities and
influencing the results.

P5.The concept of organisational behaviour
It is the study of behaviour of human, the affiliate between human behaviour and the
organisation itself. Some of the major concepts relates to the significance of organisational
behaviour will be discussed below -
Employees perception
Its the way how a person sees, learn or understand thing while in NHS staff may welcome a
given policy while another may reject at the ground level. This might be possible that the higher
job satisfaction in NHS is directly connected with improved patient result. Moreover, it aims to
estimate the potential staff to be used as an indicator of institutional achievement across all NHS.
Differences in individual
People may differ in their physical character along with their psychological attributes. As in
NHS its essential for manager to get the best out of every employee (Banerjee and Srivastava,
2017). People using healthcare services should be treated as an individual or important
components of their overall experiences and should maintain their dignity during a stressful
period because each patient experiences healthcare is different.
Employees motivation
In order to aim hard, people need different kinds of motivation. People consider as the most vital
asset of the organisation while the motivated staff are the best medicine for NHS. For the
successful healthcare services ,should have deliberate and long term focus on patient value which
deliberately empower the professionals of NHS along with provide greater autonomy.
Dignity of labour
The management should be treated as care and respect. NHS considering the factor related to fair
wages, healthy work surroundings, job security, provide proper training facilities and
encouraging employees decision making specify that the management respect the dignity of
labour (Chión , Charles and Morales, 2019). As in the workplace, if the management serve their
labour as a commodity that can be obtain by a cost than human interrelationship bound to
become more deficient.
Social system
The formal or informal system exits in any company, formal is deliberately created while
informal naturally exist. NHS follows the principal of socialist and represent the socialism in the

area of capitalist (Nene and Pillay, 2019). All the mechanism of socialism merely in the sense of
the distributing healthcare without considering the deeper transformation relating with doctor-
patient connection and prevention.
Interest of mutuality
This concept is making no sense when there is mutuality of interest without having collection of
people. This address in NHS the maximum quality at the lower price by eradication the layers of
management and creating general practitioners the main purchasers. Similarly, its the NHS role
to satisfies the needs of the people because its the employee only who work for the
accomplishment of the organizational objectives.
P6.The impact of performance at the workplace in relation with motivation, organisational
behaviour and reflection
Motivation
Motivation refers as directing, energizing, supporting or encouraging the efforts of the
employees. When a team is motivated they will be excited in performing the task. Alderfer ERG
theory explained the three steps of needs namely existence, relatedness and growth. This theory
try to describe how all these needs become more or less essential to any person. Existence needs
includes a person's physical health or safety or psychology needs and involves more or less basic
needs or how it will fulfil. In the National health services, it is concern for the manager to find
out what motivates people and its essential to find out about the factor because its effect the
overall performance of the health care organization. Conversely, if the manager determine what
motivate an individual than they assist employee in achieving their potential (Patyal and
Koilakuntla ,2016). Relatedness theory involves exterior component or social needs or aspire
towards reaching recognition or fame. It might be possible in NHS, there were the staff who did
not deliver the services with the more compassion to form basic relationship with patients as a
result there will be no proper communication occur and the patient fell insecure about the
services offered. If the healthcare department maintain the patient-nurse relationship successfully
then a higher level of the growth or results is achieved. In growth theory, the self-development,
individual growth and advancement all together form this need. An irrelevant impact is occur
when this need is not accomplished and also ruin the image of the NHS. The patient feel more
confidence, compassion than it will definitely increase the survival rate of organisation.
Reflection

It is related to the work practices where an individual learn from their own or either from each
other's experiences. It is one of the most essential source of personal development or
improvement in NHS. Reflection practices particularly imperative in achieving feedback
interventions. As a result of this feedback, it is believed that NHS management team definitely
direct, reward or motivate employees behaviour and after receiving the summary of the feedback
explains that it doesn't generate indisputable positive effects on performance with a fundamental
number of report shown zero negative impacts (Turiand and Sorooshian, 2019). This factor on
the other hand, allows member of NHS to set back from there own action and provides them with
formal training or equipped tools or through structured activities to assist them with the help of
the reflection theory to recognize what they have actually understand from it. This will help
company to focus more on the efficiency of the work and decrease the disputes or difference that
usually occur between the employees if every other individual started focuses on their particular
activities.
CONCLUSION
It has been concluded that, the above report explains how the overall structure or concepts of the
organisational behaviour effect the performance of the overall team. The report also go through
and explain relation with the motivation along with the briefly elaboration of reflection practices
and its benefits or drawbacks that eventually effect the accomplishment of the NHS.
Additionally, the various approaches to management styles of NHS and suggests the most
effective approach that suits the organisation. The role and impact of central and local
government and also the part of National health services in making the services more
accountable.

REFERENCES
Books and Journals
Ali Taha, V., Sirkova, M. and Ferencova, M., 2016. The impact of organizational culture on
creativity and innovation. Polish Journal of Management Studies.14.
Banerjee, S. and Srivastava, D., 2017. Innovation, Organisational Structure, and Culture: Its
Impact and Linkage on Organization-A Review. International Journal of Civic
Engagement and Social Change (IJCESC).4(1). pp.1-22.
Bearman, G.M. and Vokes, R.A., 2019. Averting a betrayal of trust: system and individual
accountability in healthcare infection prevention. Infection Control & Hospital
Epidemiology. 40(8). pp.918-919.
Bhatia, M. and Sood, S.K., 2016. Temporal informative analysis in smart-ICU monitoring: M-
HealthCare perspective. Journal of medical systems. 40(8). p.190.
Bishwas, S.K. and Sushil, 2020. Environmental uncertainty, leadership and organisation culture
as predictors of strategic knowledge management and flexibility. International
Journal of Knowledge Management Studies. 11(4). pp.393-407.
Chandwaskar, P., 2019. TLP for Organisation Theory, Structure and Design 2018-2019.
Chión, S.J., Charles, V. and Morales, J., 2019. The impact of organisational culture,
organisational structure and technological infrastructure on process improvement
through knowledge sharing. Business Process Management Journal.
Collins, T.E., 2019. The three cultures: towards a cultural understanding of a third sector
organisation (Doctoral dissertation, University of Southampton).
Felipe, C.M., Roldán, J.L. and Leal-Rodríguez, A.L., 2017. Impact of organizational culture
values on organizational agility. Sustainability.9(12). p.2354.
Günzel-Jensen, F., Jain, A.K. and Kjeldsen, A.M., 2018. Distributed leadership in health care:
The role of formal leadership styles and organizational efficacy. Leadership. 14(1).
pp.110-133.
Kalaiarasi, M.V. and Sethuram, S., 2017. Literature review on organisation culture and its
influence. International Journal of Advanced Research in Engineering &
Management. 3(8). pp.9-14.
Nene, S.W. and Pillay, A.S., 2019. An Investigation of the Impact of Organisational Structure on
Organisational Performance. Financial Risk and Management Reviews. 5(1). pp.10-24.
Patyal, V.S. and Koilakuntla, M., 2016. Relationship between organisational culture, quality
practices and performance: conceptual framework. International Journal of Productivity
and Quality Management. 19(3). pp.319-344.
Turi, J.A. and Sorooshian, S., 2019. The impact of organisational structure on organisational
learning. Middle East Journal of Management. 6(2). pp.204-232.
Ullah, Z., Badshah, S.I. and Shaheen, M., 2017. STRATEGIC ANALYSIS OF SELECTED
CASE STUDIES FOR THEIR ORGANISATION STRUCTURE IN COMMUNITY
BASED ECOTOURISM (CBE). STRATEGIC ANALYSIS.
Winkelhake, U., 2018. Corporate Culture and Organisation. In The Digital Transformation of
the Automotive Industry (pp. 179-221). Springer, Cham.
Online

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