Organizational Design

Organizational Design

Organizational design is defined "as the manner in which a management achieves the right combination of differentiation and integration of the organization's operations, in response to the level of uncertainty in its external environment" (Business Dictionary, 2013). Each organization is structured in ways that should be beneficial to the organization, the employees, and the community. Personal HomeCare, Incorporated is the topic of this paper and the structure, external factors, and internal factors will be discussed.

Structure

Personal HomeCare, Incorporated is a small home health care agency located in South Boston, Virginia and has locations in South Hill and Lynchburg. Combined, all three locations have a total of about 256 employees, including the administrative staff. South Boston also houses human resources and billing functions. The organization caters to the elderly and disabled populations of the towns mentioned as well as the surrounding areas. Personal HomeCare also does companion care as well. The organization has been in place since 1992 (First Care, 2013).

First Care Health Services, Incorporated is the parent company of Personal HomeCare (First Care, 2013) and is owned by one individual. There are two other organizations under the First Care umbrella. Commonwealth Home Health is responsible for skilled nursing care. First Dominion also does skilled care along with home health care as well.

Personal HomeCare has a flat organizational structure. It has very few layers of management and a wider span if authority (Griffin, 2013). This type of structure leads to faster decision making, happier clients, and more satisfied employees. A flat organization communication is faster and more effective. The lines of communication are open between the aides, clients, and management. The director or operations and senior manager are in South Boston and travel to Lynchburg and South Hill. Flat organizations tend to grow more slowly than a tall organization does (Griffin, 2013).

Office staff of Personal HomeCare reports to the director. In her absence, the staff reports to the senior manager. At times, this can cause some confusion concerning the chain of command (Griffin, 2013). This can be avoided if all staff members are made aware of the chain of command.

External Factors

There are many external factors that shape the organization. One of the most important external factors is governmental rules and regulations. Personal HomeCare accepts the following payers (First Care, 2013):

o Medicaid

o Private Long-term Care Insurance

o Private Pay

o Department of Veteran's Affairs

The majority of the clients are recipients of Medicaid so the company is bound by the rules and regulations of Medicaid. Medicaid will pay only a set amount per hour of care. The pay for the aides is based on the reimbursement from Medicaid.

Long-term care insurance recipients usually have a maximum amount that will be paid to the agency. It could either be a maximum amount per day or per month. The agency is allowed to bill the insurance company for the entire amount, but the insurance will only pay a set amount. The agency will bill the client for the remainder of the charges not paid.

The aides are required to be a certified nurse aide (CNA) or hold a certificate from a state accredited personal care aide (PCA) training institution. Without one or other, the aide cannot take care of a Medicaid client. Companion care clients do not require neither CNA nor PCA care. This is called a sitter position.

When a new client is opened, a registered nurse will complete an assessment (DMAS 99) that includes:

o Functional status

 A client's ability to assist or complete the activities of daily living

o Mobility

o Orientation

o Behavior

o Joint motion

o Medical