Combining Assets and Activities
The community of Tampa, Florida, has a diverse population, with healthcare being provided to persons with low incomes,extremely wealthy individuals,

and a strong middle class. Three well-established physicians-an obstetrician, a gynecologist,and a urology specialist-decided that they should combine their practices into a unique new organization. They believed thatnumerous patients would be attracted to these separate, but interrelated, medical practices.

The three physicians worked together to create a plan. They decided that each physician would have privileges, or authorityto practice, in more than one organization. Beyond their individual practices, the doctors would perform surgeries andprovide additional medical care in several local area hospitals. In the new practice, their days would be divided into times inwhich they tend to routine examinations, to patients with medical problems that are not emergencies, to making rounds atthe hospital to check up on patients, and to conducting other medical care.

The new organization would be housed in a major medical building. A support staff, consisting of those who could help withpatient scheduling, insurance claims, billing, and other office duties, would be combined with three full-time nursingassistants. The physicians chose one individual for the role of office manager to oversee all of the support activities.

The obstetrician also employed a clinical nurse practitioner with responsibilities that would be more medically complex thanthose usually associated with nursing. The obstetrician found the practitioner's help particularly useful to her practice.

The new organization intended to hire one more person to serve as a liaison to the hospitals that the physicians attended,with the goal of ensuring smooth coordination between the newly formed organization and the hospitals. The new personwould be in charge of resolving any disputes or disagreements.

This new organization, which had yet to determine its name, would be a partnership. The three physicians would shareauthority and the direction of the medical practice. Decisions about difficult issues, such as adding a new form of care orbringing in an additional partner, would be made by majority rule, or agreement by two of the three doctors. The threephysicians agreed that they should eventually grow to the point at which each had a second specialist in his or her area,which would expand the organization to six doctors. They believed the benefit of such growth would be having a person toanswer calls when another specialist was unavailable. It would also potentially increase the number of specific medicalprocedures the unit would be able to offer to the community.

With these principles in mind, the physicians agreed it was time to design the organization.

Describe the vertical and horizontal dimensions of this organization. Describe the authority and responsibilityrelationships present in this organization.
Should this practice become centralized, decentralized, mechanistic, or organic in its design? Defend your answer.
Explain the importance of differentiation; integration; and managing complexity, interdependence, and boundary-spanningactivities for this organization.