| Course | EDN 810 The Nature of Health Care Organizations and Systems |
|---|---|
| Module | Module 1 |
| Paper type | Organizational structure analysis |
| Length | About 1,138 words, 7 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | Doctor of Education |
| Updated | September 2026 |
Free sample paper for EDN 810 Module 1
Boxes, Lines and Patients: Organizational Structure in a Regional Health System
Student Name
Doctor of Education Program, Aspen University
EDN 810: The Nature of Health Care Organizations and Systems
Instructor Name
Month Day, Year
Boxes, Lines and Patients: Organizational Structure in a Regional Health System
An organization's structure determines who decides, who reports to whom and how work is coordinated. In health care, structure shapes how quickly a patient moves from the emergency department to a bed, whether nurses and physicians plan care together and how leaders learn about problems. The subject here is the design of a composite nonprofit regional system, 9,200 employees strong across three hospitals and 40 clinics, as it reorganizes around clinical service lines.
Why Structure Matters
Structure is not only an administrative chart. It sets incentives, channels information and signals priorities. A structure that separates hospitals from clinics may leave patients to navigate the gap between them; one that groups services around conditions, such as heart or cancer care, may coordinate care better but create silos between service lines.
Forms of Structure
The table compares four common forms as they appear in health care.
| Form | Organized around | Strengths | Risks |
|---|---|---|---|
| Functional | Departments such as nursing, pharmacy, finance | Professional expertise; clear standards | Silos; slow coordination across departments |
| Divisional | Sites, regions or service lines | Accountability for results; focus on patients or markets | Duplication; competition between divisions |
| Matrix | Two dimensions, such as service line and profession | Coordination with professional oversight | Dual reporting; confusion over authority |
| Network | Partnerships with independent organizations | Reach and flexibility | Weak control; dependence on relationships |
Four Worlds of Health Care
Glouberman and Mintzberg (2001) describe health care organizations as four differentiated worlds: cure, represented by physicians; care, represented by nurses and other clinicians; control, represented by managers; and community, represented by trustees and the public. Each world has its own logic and loyalties, and the gaps between them explain much of the difficulty of coordinating care.
The Composite System Today
The system is currently organized by site: each hospital has a president, and clinics report to a separate ambulatory division. Nursing reports through each hospital's chief nursing officer to a system chief nurse executive. Physicians are partly employed and partly independent. Patients with heart failure, for example, move among three sites and several clinics with little shared planning. Plsek and Greenhalgh (2001) remind leaders that clinical organizations adapt from within: formal lines influence people's interactions without dictating them.
The Move to Service Lines
Leaders plan to create service lines for heart, cancer, women's health, orthopedics and behavioral health, each led by a physician and nurse dyad responsible for quality, cost and growth across all sites. Hospitals and clinics will remain as operating units, creating a matrix in which staff answer to both a site leader and a service line leader.
Where Nursing Leadership Sits
In the new structure, the chief nurse executive sits on the system executive team, and each service line has a nurse co-leader. This placement gives nursing a voice in strategy and budget decisions, not only in operations. Nurse leaders will need skills in finance, data and negotiation to use that voice effectively.
Governance and the Board
The board of trustees sets direction, approves major investments and oversees quality and safety. Board members represent the community world. A quality committee receives reports from each service line, linking governance to the care patients receive.
Spans of Control
Nurse managers in the system oversee an average of 85 staff, a span that limits time for coaching and quality work. The reorganization adds assistant managers on large units, reducing spans to about 45. Narrower spans support engagement and safety but increase management costs.
Structure and Quality
No structure guarantees quality, but structure can make coordination easier or harder. Service lines may improve coordination for patients with specific conditions, while patients with several conditions may fall between lines. The plan designates a complex care team that works across service lines for such patients.
Risks of Reorganization
Reorganizations consume attention and can disrupt relationships. Burns and Pauly (2018) caution that many promised gains from restructuring and integration in health care have not materialized, which argues for modest expectations and careful measurement. Matrix structures often create confusion about who decides. Clear decision rights, published for each type of decision, and a joint site and service line council for conflicts reduce these risks.
Recommendations
The system should proceed with service lines, define decision rights clearly, keep nursing in dyad leadership at every level, reduce manager spans on large units and establish a complex care team. It should evaluate the change after 18 months using measures of coordination, quality, staff engagement and cost. A post-implementation review will ask front-line staff whether the new structure made their work easier or harder.
Informal Structure
Beneath the chart lies an informal structure of relationships, trust and influence. A charge nurse with long tenure may shape unit decisions more than a new manager; a respected hospitalist may sway physician opinion more than a department chair. Leaders who map informal networks can use them to spread changes that formal lines alone would not carry.
Structure and Information Flow
Structure determines how information travels. In the current site-based structure, quality data rise to each hospital's leadership but rarely cross to other sites, so a problem solved at one hospital may persist at another. Service lines with system-wide dashboards should allow faster learning across sites, if leaders use them.
Lessons From Other Systems
Systems that have moved to service lines report better coordination for targeted conditions but also new silos between lines and tension with site leaders. Their experience suggests starting with a few service lines, defining shared goals with sites and revisiting the design after a year rather than reorganizing everything at once.
The Role of Middle Managers
Middle managers translate structure into daily work. In a matrix, they receive direction from two leaders and must reconcile competing priorities. Training managers in negotiation and giving them clear escalation paths helps them work within the new structure rather than being caught between its lines.
Measuring Structural Change
The system will track time from emergency department decision to admission, readmissions for service line conditions, staff engagement scores and manager turnover before and after reorganization. These measures show whether the new structure improves coordination without harming the people who work within it.
Structure and Nursing Practice
Structure affects nursing practice directly. Shared governance councils, in which staff nurses help set practice standards, give nurses authority over their work. The reorganization will keep unit and system councils and give each service line a nursing practice council, so that structural change strengthens rather than weakens professional voice.
Conclusion
Structure shapes how health care organizations coordinate work across the worlds of cure, care, control and community. The composite system's move from site-based to service line organization, with a matrix and dyad leadership, promises better coordination but brings risks of confusion and silos. Clear decision rights, strong nursing leadership and attention to patients who cross service lines will determine whether the new structure serves patients better.
References
Burns, L. R., & Pauly, M. V. (2018). Transformation of the health care industry: Curb your enthusiasm? The Milbank Quarterly, 96(1), 57-109. https://doi.org/10.1111/1468-0009.12312
Glouberman, S., & Mintzberg, H. (2001). Managing the care of health and the cure of disease: Part I: Differentiation. Health Care Management Review, 26(1), 56-69. https://doi.org/10.1097/00004010-200101000-00006
Plsek, P. E., & Greenhalgh, T. (2001). The challenge of complexity in health care. BMJ, 323(7313), 625-628. https://doi.org/10.1136/bmj.323.7313.625
Reading the EDN 810 Module 1 assignment instructions
Aspen lists the organizational structure of health care systems first among EDN 810's topics, and because the Module 1 prompt stays inside the classroom, this example takes that topic as its assignment: analyze how one health system is organized and whether its design serves patients. Assignments of this kind usually want three things. First, a description of the current design that goes beyond boxes on a chart to reporting lines, decision rights and who controls budgets. Second, a comparison of at least three structural forms, with the strengths and risks of each in a health care setting. Third, recommendations that say what should change, what the change will cost in disruption and how you will know it worked. Doctoral instructors also expect nursing leadership and shared governance to sit inside the design rather than beside it.
How this EDN 810 Module 1 example is built
The example opens with the consequences of structure for patients, then compares functional, divisional, matrix and network forms in a four-column table before applying Glouberman and Mintzberg's four worlds of cure, care, control and community. From there it describes the composite system as it stands, a nonprofit with 9,200 employees across three hospitals and 40 clinics, and the planned move to service lines for heart, cancer, women's health, orthopedics and behavioral health, each run by a physician and nurse dyad. Separate sections place the system chief nurse executive in the new design, explain how the board's role changes, set spans of control and connect structure to quality results. Later sections turn to what an organization chart hides: informal networks, the path information takes and the middle managers who carry dual reporting.
EDN 810 Module 1 rubric: what earns full marks
A structure paper earns most of its marks for accuracy and judgment: describing the organization correctly, comparing forms fairly, linking design to performance and recommending changes a leadership team could act on. This sample supports its claims with three APA sources, Glouberman and Mintzberg's Health Care Management Review article, Plsek and Greenhalgh's BMJ essay on complexity and Burns and Pauly's Milbank Quarterly critique of industry transformation. The comparison table is where the analysis becomes visible, so it names a risk for every form, including the matrix the system chooses. Graders reading at the doctoral level look for testable recommendations, which is why measures of success are set before the reorganization begins. Attention to spans of control and support for middle managers under dual reporting shows the design has been thought through where the work happens.
EDN 810 Module 1 help: mistakes that cost marks
The most frequent weakness in structure papers is a chart with no consequences: the student describes who reports to whom but never says how that arrangement slows a decision, splits accountability or changes what a patient experiences. A second weakness is the recommendation to reorganize with no mention of cost, disruption or the months of confusion a new reporting line brings. Before drafting, follow one patient through your organization and note every handoff between departments; that trace often shows the structural problem more clearly than the chart does. Ask two front-line staff where decisions stall and whom they turn to when the formal route fails. If your own organization's chart is confidential, a tutor can help you build a realistic composite so the analysis stays specific.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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EDN 810 Module 1 questions, answered
What does EDN 810 Module 1 usually ask for?
Aspen's EDN 810 covers the organizational structure of health care systems, so an analysis of an organization's structure is a typical first assignment. Follow your classroom prompt.
What is a service line structure?
Organizing clinical services around conditions or populations, such as heart or cancer care, across sites.
What are the four worlds of health care?
Cure, care, control and community, each with its own logic, as described by Glouberman and Mintzberg.
Where can I find a free EDN 810 Module 1 sample paper?
The structure analysis is above, with a table comparing functional, divisional, matrix and network forms in health care.
How is health care organizational structure analyzed in EDN 810 Module 1?
By describing reporting lines and decision rights, comparing structural forms, linking structure to coordination and quality and recommending measurable changes.