HCS/325 Week 2: Teamwork, Communication, and Organizational Structure, sample paper

From Silos to Service-Line Teams: How Structure, Communication, and Team Development Shaped a Hospital Imaging Department's Reorganization

[Student Name]

University of Phoenix

HCS/325: Health Care Management

Week 2 Assignment

[Instructor Name]

[Date]

The hospital, department and staff are a composite written for a model paper.

A composite 300-bed hospital's imaging department was organized by modality: CT, MRI, ultrasound and x-ray each had its own supervisor, schedule and staff, and each reported separately to the imaging director. The structure worked for routine volume. It failed for urgent patients who needed more than one study. In one month, three emergency department patients with suspected stroke waited more than 40 minutes between CT and CT angiography because the ordering, scheduling and technologist assignments ran through different sections that did not share information in real time. Every section was doing its own job well, and the patient still fell through the space between them. This paper examines how the department's reorganization addressed structure, communication and teamwork together.

The Original Structure and Its Costs

A functional structure groups employees by specialized function, which builds deep expertise and clear lines of authority. Health care management texts note that such structures are efficient for stable, repetitive work but can create silos, slow coordination across functions and push problems up the hierarchy for resolution (Buchbinder et al., 2021). Mintzberg (1979) described how organizations coordinate work through mutual adjustment, direct supervision and standardization, and how the choice of grouping determines which coordination is easy and which is hard. Grouping by modality made coordination within CT easy and coordination between CT and MRI hard.

The costs appeared in communication. An emergency order for CT and CT angiography went to the CT section's queue; if the patient also needed MRI, a second order went to a different queue with a different supervisor. Information moved vertically, from technologist to supervisor to director and back down, rather than laterally among the people caring for the same patient. Handoffs between sections relied on phone calls that were often not returned during busy periods.

The New Structure

After reviewing the delays, the imaging director reorganized the department into three service-line teams: emergency and inpatient acute imaging, outpatient scheduled imaging and interventional and procedural imaging. Each team included technologists from multiple modalities, a team lead and a dedicated scheduler, and each team shared a common work queue showing all of its patients' studies across modalities. Modality expertise was preserved through a small group of modality specialists who set protocols and trained staff across teams.

The new design groups people around patient flow rather than equipment, making lateral coordination easier for the patients who need it most. It also created a trade-off: technologists were now responsible for more than one modality within their team's scope, which required cross-training, and supervisors lost direct control over all staff of their specialty.

Communication Tools Added

Structure alone does not guarantee communication. Leonard et al. (2004) argued that communication failures are a leading cause of harm in health care and recommended structured tools, such as SBAR, briefings and a shared language for escalating concerns, to create a common mental model among team members. The department adopted three such tools. Each team held a five-minute huddle at the start of each shift to review pending urgent studies and staffing. Handoffs between modalities used a brief SBAR format entered in the shared queue rather than by phone. And any team member could flag an urgent study as a "priority hold," which paused routine scheduling until the urgent study was underway.

Team Development

Tuckman (1965), reviewing studies of small groups, proposed that teams develop through stages of forming, storming, norming and performing. The imaging teams went through each. In the forming stage, staff were polite and uncertain, relying on the team leads for direction. Storming came within weeks: CT technologists resented covering x-ray on busy nights, and some MRI technologists felt their specialized skills were undervalued. Two senior technologists requested transfers. The director treated the conflict as expected rather than as failure, met with each team to hear concerns and adjusted cross-training so that each technologist covered no more than two modalities. Norming followed as teams agreed on huddle routines, coverage rules and how to request help. By the fourth month, the emergency and inpatient team was performing: members anticipated each other's needs and resolved most coverage issues without escalation.

The Manager's Role in Communication

The director's own communication shaped the reorganization as much as the new tools. She announced the change in person at meetings on every shift rather than by email, explained the stroke delays that prompted it and admitted that the new structure would ask more of technologists before it made their work easier. She created a weekly open question session in the first two months where any staff member could raise problems, and she reported back on what had changed as a result. When the two senior technologists requested transfers, she met with each privately, thanked them for their years of service and asked what would have made the change work for them; one of their suggestions, limiting cross-training to two modalities, became policy. Communication that is honest about costs and responsive to feedback builds the trust a reorganization needs.

Results

After six months, the median time from CT to CT angiography for stroke alerts fell from 34 minutes to 11 minutes, and no urgent study waited more than 20 minutes between modalities. Staff survey scores for "I know who to call when I need help" rose substantially. Overtime initially increased during cross-training and then returned to baseline. Two technologists left during the storming stage, which the director considered a real cost of the change.

Lessons for Health Care Managers

Three lessons emerged. First, structure determines who talks to whom; if patients need coordination across groups, the structure should make that coordination routine. Second, a new structure needs new communication habits, such as huddles and shared queues, or old patterns persist. Third, team conflict after a reorganization is a normal stage of development, and a manager who expects storming can guide a team through it rather than reversing the change.

Conclusion

An imaging department organized by modality produced skilled sections that did not communicate well across their boundaries, and urgent patients paid for the gaps. Reorganizing into service-line teams, supported by structured communication tools and a manager who understood team development, reduced delays and improved staff confidence at the cost of some turnover and a difficult first few months. Structure, communication and teamwork are not separate subjects; in practice, each one shapes the others.

References

Buchbinder, S. B., Shanks, N. H., & Kite, B. J. (Eds.). (2021). Introduction to health care management (4th ed.). Jones & Bartlett Learning.

Leonard, M., Graham, S., & Bonacum, D. (2004). The human factor: The critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care, 13(Suppl. 1), i85-i90. https://doi.org/10.1136/qshc.2004.010033

Mintzberg, H. (1979). The structuring of organizations. Prentice-Hall.

Tuckman, B. W. (1965). Developmental sequence in small groups. Psychological Bulletin, 63(6), 384-399. https://doi.org/10.1037/h0022100