The organizational structure of hospitals is considered a vertical structure with many layers of management. The majority of staff works in very specific, narrow, low-authority roles. This structure results in a bureaucratic structure including the following:

Specialization: The hospital staff consists of dozens of specialists in a variety of fields each with required credentials and accreditations.

Hierarchy of Authority: The vertical structure consists of a top down approach with the Board of Directors at the top. The next level includes executives, of which there is a CEO, chief nursing officers, chief medical officers, chief information officers, chief financial officers and chief operating officers. Department administrators follow in order, and there are clinical administrators for each department such as the emergency room, orthopedics, labor and delivery, dietary, pharmacy, and housekeeping. Next are the patient care managers, including nurse managers, directors of rehabilitation services, and supervising physicians who have people under them who give hands-on patient care. The last level is the service provider, such as nurses and physical therapists to line cooks and laundry workers.

Rules and Regulations: The hospital is highly regulated by federal and state requirements and the Joint Commission, which conducts an on-site audit. A hospital will begin preparing for an audit over a year in advance.

Technical Competence: The hospital employs medical staff and technicians with a high level of technical competence to operate the high tech equipment such as MRI’s and robotic-assisted surgery equipment.

Formal Written Communication: Formal policies are circulated and electronic memos are commonplace in hospitals. Electronic charts are replacing written charts allowing for capturing more specific and consistent information via checklists.

All of these characteristics are readily visible in a hospital and contribute to a bureaucratic structure.