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1、OrganizationalArchitectureandtheProcessofManagementInnovationCHAPTER23CHAPTEROUTLINEManagementInnovationsTheDemandforManagementInnovationsTheRiseofTQMOtherInnovationsWhyManagementInnovationsOftenFailMarketingUnderestimatingCostsofChangeFailuretoConsiderOt
2、herLegsoftheStoolManagingChangesinOrganizationalArchitectureSummaryumanaHospital,a555-bedinstitutioninDallas,Texas,fundamentallyreorganizedthewayitwasstructuredfordeliveringcaretoitspatients.Be-ginningin1990,itappliedaprocesscalledreengineeringtodeveloppa
3、tient-Hfocusedcare,enhancingthedeliveryofhealthcareandreducingcosts.1Hospitalcostsinthe1980sandearly1990shadincreasedfasterthaninflation,therebyprecipitatingahealthcarecrisis.Thepartiesthatpaidforhealthcareservices—privateindividuals,employers,insurancecom
4、panies,andthegovernment—borethehigherexpenses.Tostemtherisinghealthcarecosts,thegovernmentbeganreimbursinghospitalsusingafixedfeeforeachprocedureratherthanpayingfortotalcostsincurred.Andlargeemployers,throughtheirinsurancecompanies,begantopressurelocalheal
5、thcareprovidersbythreateningtorequirethattheiremployeesbetreatedonlyatthosehospitalsandbythosephysiciansthatbettercontrolledcosts.Asaresult,hospitalsiniti-atedcostcontainmentprogramsandbegancompetingforpatients.Priortoreengineering,Humanaemployedthetradit
6、ionalhospitalarchitecturewhereinpatientcarewasprovidedprimarilybyfunctionallyorganizedindividuals:physi-cians,nurses,andascoreofspecialistsdrawingbloodsamplesandtakingxraysandadministeringEKGs.Mostlargehospitalsareorganizedaroundnumerous,small,clinicallyf
7、ocusednursingunitswithdedicatedstaffsandlargecentrallydispatchedservices—physicaltherapists,phlebotomists,andtransporters,forinstance.Theyhave60to100de-partmentheadsandseventoninelayersofmanagementbetweenCEOandbedside1DetailsofthisexamplearefromJ.Lathrop(
8、1991),“ThePatient-FocusedHospital,”HealthcareForumJournal(July–August),17–20.23-2Part4ApplicationsofOrganizationalArchitecturecaregiver.Patientcareunitsgenerallyaredesignedwithexcesscapacity;thisenablesthemtohandlea
