In most health care settings, it is unlikely that you would hear the terms “ad hoc” or “matrix” as you walk down the hallway.

In most health care settings, it is unlikely that you would hear the terms “ad hoc” or “matrix” as you walk down the hallway. Although it is helpful for any organization to delineate pathways of responsibility and authority in an organizational chart, the lived experience of these structures is most apparent through the inquiries and behaviors people share everyday.

In your own workplace, you may find yourself wondering, who should I turn to when I have a practice dilemma? or Where can I go to learn more about this issue? These questions speak to the intricacies of formal and informal organizational structure and leadership.

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To prepare:

• Consider the overall structure or hierarchy of your organization or one with which you are familiar. Which organizational structure best describes your organization—line (or bureaucratic), ad hoc, matrix, service line, or flat? Note: It is possible to have a combination of structures in one organization. Is decision making centralized or decentralized in this organization?
• What is the role of committees, task forces, and councils in the organization, and who is invited to join? Consider how this relates to formal and informal leadership.
• Reflect on how decisions are made within a specific department or unit. Which stakeholders provide input or influence the decision-making process? Assess this in terms of formal and informal leadership.
• To support your analysis, consider your own experiences and investigate these matters by speaking with others at the organization and reviewing available documents. Be sure to consider how the concepts of formal and informal structure and leadership relate to one another and are demonstrated in the organization and in the particular department or unit.