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The organization for the purpose of study is Apollo Hospitals Ltd., a chain of healthcare service providers present across the globe and the third largest private healthcare providers in the world. The organization chosen is large, employing over one hundred thousand people across and has emerged as the centre of excellence in providing healthcare services.
This large organization is a pyramid with the founding family and its five members controlling the operations of the organization across. The family is assisted by a set of Senior Vice-presidents who run a geographic region consisting of a large number of centres. Each of the Senior Vice-presidents is assisted by a team of specialist Vice-presidents who in turn have specialist teams. There are line and staff functions clearly demarcated here. The primary healthcare services is conducted by a group of senior doctors across which there is a clear hierarchy again. The staff function of administration, Human Resources, Finance, Accounts, Procurement etc. are again headed by able professionals and have designations right upto the Vice-presidents in each department.
The line functions consist essentially of medical care providers, nursing care providers, Electronic Health Record keepers and Technicians. Staff function consists of the other support and administrative services. There is inevitably bureaucracy that creeps in – the line would need material or other support and the support believes that they are the key people. Line believes since they are dispensing care, they are the key people and egos tend to get rubbed occasionally and there is conflict invariably.
The organization is clearly pyramid in nature and has a lower strata or the starting level of employees that are young, in-experienced and want to show off the brand that they are working for, gain experience and leave for greener pastures. The strategy team of the organization is aware of this and keep the wages, perks and other benefits very low keeping the cost of operations low and hence maintaining higher levels of profitability.
The processes are fairly well documented and very rigid with very little possibility of change or modification or even improvement. The staff function go about in a very mechanical manner about their job. Whatever changes happen at the top and are top-driven.
The ideology and the managerial approach is embroiled deeply in bureaucracy. The procedures are distilled into Standard Operating Procedures (SOPs) and it is expected that these are not violated under any circumstances. Any violation of SOP is seen and construed as a serious error and all decision making is referred to an SOP and is subservient to it.
Motivation comes in the form of ensuring that the increased workload is attended to and completed on a daily basis. The supervisors strictly adhere to their set of people that they work with and prefer not to interfere in others’ work. What is not in the SOP is not relevant at all. While this is done on a day-to-day operational basis there is also another angle where the employees are rewarded with a material benefit or a reward regularly. Theory X and Y are at play.
Employee engagement programs are part of the culture, however these again are restricted to the senior set of people while the juniors in the hierarchy continue to be spectators. Punishments are rare but are again in the philosophy to improve working efficiency and following of SOPs. There is a change that is happening at the ownership level where the founder owner of the organization is slowly taking a back seat allowing the third generation of the family to start taking control. This is bringing in a whiff of air and things seem to be changing with the younger members wanting to take decisions differently and view things in a different manner.
There is a definite social system that exists and one pre-dominant factor is the respect for the designation – this respect itself is a biggest motivator. This workplace is itself is a microcosm of the complete society. Employees who have stayed here since the hospital started working know everything that the founder went through to put up the hospital and get it going. Almost everybody knows everybody especially in the ranks. They all know the seniors – supervisors, and managers and other seniors in the hierarchy. They are a pretty closed group.
The seniors in the organization especially higher in the ranks tend to have their own social system and social circle within the organization. There is very little socialization that is seen across the ranks. Outsiders and newcomers are not easily welcome into the system. It takes a lot of time and patience as well as hard work for the newcomer to get accepted and the proof of loyalty has to be there for the newcomer to be accepted – a typical small town kind of feeling and behaviour. Many older employees have direct access to the founders and their family directly because of the fact that they were among the first employees to be hired by the organization. Newer but senior employees lack that. There is a definite sense of power and even influence that they wield. There are definite groups within that play a definite kind of role and influence – sometimes negative and sometimes positive.
The organization is a thriving and alive political institution. Bureaucracy or the senior officials in the organization are aware of the real union situation that exists and the political happenings there in. However there is a kind of a power play all over the organization to either prove who is closer to the founder and his family or to prove who is closer to the managers and the bureaucracy. Then there are dynamics among the supervisors and managers to prove who is better and who has better control over the people in the organization.
Every head of the department tries to influence decisions in a manner to establish his or her supremacy in the happenings. Everyone acknowledges the politics and the dynamics that are happening there and keep saying that it is bad for the organization. However everyone indulges in this favourite pastime because they feel that it is the life blood and without which they will not be in the main stream of the happenings. There is a kind of a coterie within a coterie within a coterie kind of a situation. Everyone has the need to belong to a coterie. Every manager’s whim and decision is a kind of a ruling for the coterie to implement and follow.
Everyone is aware of the sway that they hold and how important they are within the political system. And within all this the quality of delivery does not suffer towards the patients and the patients get the best of medical attention comparable to any other great organization across the globe. Such is the efficiency of this system.
Decision making in the organization is driven strictly by the SOPs in place. There is hardly a scope for an independent decision, because it is all in the book. This structured approach has been taken even into the medical side of things. For instance if a patient who has undergone a bypass surgery needs to be evaluated for discharge there is a scale of 1000 points that are built in. There are 8 parameters on which the patient is rated. Each parameter has several grading with specific points allotted to each grade. The patient is rated and the points allotted summed up. If the total points are more than 700 the patient is ready for discharge! This kind of structured approach is built in into each operational aspect of the business and there are formats that need to be built that dictate the decisions. So there are hardly decisions to be made by individuals because the structure and the formats make the appropriate decisions.
There are strict operational boundaries that everyone works within. The business decisions are made at the top – very top. The decisions flow from top down and just need to be implemented. There is hardly any questioning or rationalizing that happens. Feedback hardly flows back to the top and when it does, there is a definite remedy that happens. Though rare this is sure. This is the reason why people – everyone in the organization tries to belong to the coterie of the very top and that coterie is large. For example the length of the ID card tags is fixed and every employee is given the same tag. If a very tall person joins the organization this tag looks very small and if that needs to be changed it has to go right up to the CEO of the organization. This is an example of an a-rational decision.
Policies are set and cast in stone. Policies cannot be changed. For new policies to come in they get initiated right at the top. And then they flow down the hierarchy. The policies are made in a very predictable manner. The focus is on acquiring cutting edge technology in all aspects of business since, this is the only way to remain on top of the business. Many a time polices are made that are not fully congruent with the external realities. This has to go back to the very top and get modified. This takes time and there could be even market impacts. But that is how it works.
Comparative / Contextual / Environmental School
The organization is unique in terms of its approach to culture and belongingness. There is a sense of pride in being there and being part of the larger team. There is very little of the environmental impact that hits this organization since they are a market leader and almost equal to the next four competitors put together. So whatever happens in the market the leader has the luxury to be able to respond in good time. Since the leader is always ahead, the rest of the competition looks to them to create their own market moves. The organization resembles more of a star rated hotel than a hospital and the patients become guests! There is a great uniqueness that can be attributed to this organization and can be a subject of a good interesting study.
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