NU512 Unit 3 organizational lens analysis example

Differentiated and Barely Integrated: A Structural Lens Analysis of Late First Therapy Sessions on a Composite Acute Rehabilitation Unit

[Student Name]

Purdue University Global

NU512: Leadership, Organizational Theory, and Behavior

Unit 3 Assignment

[Instructor Name]

[Date]

The unit and its schedule counts are composite and bracketed; the organizational theory and regulation cited are published.

The Problem

Over six weeks, the unit's therapy schedules booked [312] first sessions of the day for 0800 or 0830. Of these, [71], about 23 percent, started more than ten minutes late or were missed. Therapists' notes gave the reason in most cases: the patient was not yet toileted, not yet medicated for pain, not yet dressed, or still eating breakfast. Late first sessions matter clinically and financially. Patients in an inpatient rehabilitation facility are generally expected to receive an intensive therapy program, typically about three hours a day at least five days a week (42 C.F.R. § 412.622, 2024). A missed morning session is hard to recover later in the day, and patients who fall short of the expected intensity may be discharged with less functional gain.

Choosing a Lens

Bolman and Deal (2021) describe four frames for reading an organization: structural, human resource, political and symbolic. Three were considered here, and two set aside.

Political. A political reading looks for groups contesting scarce resources or advancing their interests at others' expense. It fails the first test: no group gains from late sessions. Therapists lose billable minutes, nurses are criticized, patients lose therapy, and the hospital's intensity metrics suffer. Nobody is contesting a resource in the first hour of the day.

Cultural or symbolic. A cultural reading looks for shared meanings and values that produce behavior. It explains some attitudes, such as a nursing view that morning care should not be rushed and a therapy view that nurses do not value rehabilitation. But it does not explain the timing. The problem clusters in the first hour of the therapy day and nearly disappears after 1000, while attitudes, if they were the cause, would not follow the clock.

Structural. A structural reading explains exactly what the others miss: the problem sits at the point where two groups organized around different clocks must hand off the same patient.

Differentiation: Two Groups Built for Different Work

Lawrence and Lorsch (1967) argued that organizations facing complex tasks divide into subunits that differ from one another in systematic ways, and that the right amount of differentiation depends on each subunit's task. They described four dimensions of difference. Applied to nursing and therapy on this unit:

1. Goal orientation. Nursing: safety, symptom control and daily care across the whole stay; measured on falls, pressure injuries and patient experience. Therapy: functional gain; measured on minutes delivered and change in mobility and self-care scores.

2. Time orientation. Nursing: twelve-hour shifts with a 0700 change of shift and an 0800 medication pass; the day is continuous. Therapy: eight-hour clinicians whose day starts at 0800 and is scheduled in thirty- to sixty-minute blocks.

3. Interpersonal orientation. Nursing: team-based within the shift, with frequent handoffs. Therapy: one clinician to one patient for each session, with peer consultation.

4. Formality of structure. Nursing: assignment by shift, flexible within it. Therapy: a fixed daily grid built the afternoon before.

Each difference is appropriate. Nursing must cover twenty-four hours with continuous care; therapy must deliver measured, scheduled intensity. The paper does not argue that either group should be organized like the other.

Integration: Too Weak for the Differences

Lawrence and Lorsch's central finding was that high-performing organizations matched high differentiation with correspondingly strong integration, through integrating roles, cross-unit teams and shared planning. On this unit, integration between nursing and therapy consists of three things: the therapy grid posted at the nurses' station the afternoon before, a weekly team conference that focuses on discharge rather than daily schedules, and informal conversations. The failed 0815 huddle was the only integrating device designed for the morning, and it collapsed because its cost fell on therapy and its design excluded them.

The timing of late sessions follows directly. The first hour of the therapy day, 0800 to 0900, is the hour in which nursing's clock is most crowded: shift report has just ended, medications are being passed and patients are being washed and dressed. It is also the hour in which therapy's grid is least flexible, because the first sessions were fixed the afternoon before without knowing how the night went. Two differentiated systems collide at their most rigid points, and nothing sits between them.

Testing the Diagnosis Against the Unit's Own Exceptions

A good diagnosis should also explain the exceptions. On [two] days during the six weeks, late first sessions fell to almost none. On both days, the same senior physical therapist and the same day charge nurse happened to meet at 0700 about an unrelated equipment problem, and the therapist rearranged the first sessions after hearing which patients had had a difficult night. That coincidence acted as an informal integrating mechanism for one morning each time. A political or cultural reading has no explanation for those two days; the structural reading predicts them. The exceptions also suggest that the remedy may be modest: a brief, regular exchange between the two people who hold each group's morning information.

Implications

A structural diagnosis points to structural remedies rather than to training or exhortation. Three follow. First, an integrating role: someone, or a pair, accountable for matching the morning therapy grid with each patient's night, such as a therapy-nursing liaison or a charge nurse and senior therapist who review the grid together at 0700. Second, a shared measure: first-session start times reported to both the nurse manager and the rehabilitation services director, so the problem appears in both chains' results. Third, schedule design: a staggered therapy start, with first sessions for patients who need the most morning care set at 0830 or later. Galbraith (1974), writing on organization design, adds a caution: when coordination needs rise, an organization must either reduce the need, for example by creating slack in the schedule, or increase its capacity to process information across units. The staggered start does the first; the liaison role does the second.

Limits of the Analysis

A structural reading is not the whole truth. Attitudes between the professions are real, and a change that ignores them may still fail. The political frame may matter more once a remedy is proposed, since a staggered start changes therapists' hours and a liaison role creates a new position someone must fund. The paper chooses the structural lens because it explains the pattern in the data best, not because the others are irrelevant.

References

Bolman, L. G., & Deal, T. E. (2021). Reframing organizations: Artistry, choice, and leadership (7th ed.). Jossey-Bass.

42 C.F.R. § 412.622 (2024). https://www.ecfr.gov/current/title-42/section-412.622

Galbraith, J. R. (1974). Organization design: An information processing view. Interfaces, 4(3), 28-36. https://doi.org/10.1287/inte.4.3.28

Lawrence, P. R., & Lorsch, J. W. (1967). Differentiation and integration in complex organizations. Administrative Science Quarterly, 12(1), 1-47. https://doi.org/10.2307/2391211