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John Hopkins Hospital’s Systems and Structures

Analysis of Systems and Structures of the Johns Hopkins Hospital

In this part of the study, the reporting structure of John Hopkins Hospital is analyzed. A Board of Governors oversees the organization’s activities. It has authority over the hospital’s administration, which is the second-tier of management. Within this structure, the hospital’s administration holds formal authority, while the board exercises informal power. For example, the chairperson of the board once influenced the hospital’s Chief Executive Officer to issue a tender to procure medical supplies from a company of his choosing.

Stemming from this relationship, there are two layers of management between the Frontline staff and the highest officeholders in the organization – department and administrative levels. Hinged on this setup, the hospital’s administration is responsible for monitoring the hospital’s performance, quality and financial issues.

Interdisciplinary teams within the facility traverse different levels of management to offer specialized care. They are organized at the administrative level and communication is facilitated through group meetings that happen bi-weekly. Interactions between clinical personnel and administrative professionals is integrated by a common purpose, intent, and trust. For example, palliative care is organized around interdisciplinary team collaborations. This strategy aligns with the views of Nancarrow et al. (2013), which suggest that collaboration through regular meetings is an important part of successful teamwork. Lastly, the hospital’s service lines are organized around clinical interventions, such as radiology or surgery.

Comparison of Frameworks

Two analytical frameworks selected for review in this paper are Senge’s model for developing learning organizations and the complex adaptive system (CAS). Both models are explained in the articles authored by Elkin, Zhang, and Cone (2011) and Nesse, Kutcher, Wood, and Rummans (2010). Senge’s model differs from the CAS framework because it investigates personal or individual attributes of systems thinking, while the latter mainly focuses on analyzing interdisciplinary insights in adaptive change environments. Unlike Senge’s model, which primarily focuses on five key tenets of analysis, the CAS framework is adaptive to change-initiating events.

The CAS system could be useful in understanding the workings and structures of big hospitals, such as John Hopkins, which has dynamic service delivery processes. Its relevance in this regard is pegged on its capacity to investigate complex and dynamic networks of operational processes. Comparatively, Senge’s model cold be useful in analyzing the hospital’s organizational structure by not only explaining the nature of the hospital’s systems, but also investigating how to improve them.

For example, it could be instrumental in improving the design of the organization’s service lines from intervention to population-based frameworks. Such progress could ultimately improve the hospital’s performance. Overall, based on the unique characteristics of each model discussed above, Senge’s framework is appropriate for organizations that are undergoing periods of transformative change, while the CAS framework is useful in organizations that have vast operations.


Elkin, G., Zhang, H., & Cone, M. (2011). The acceptance of Senge’s learning organization model among managers in China: An interview study. International Journal of Management, 28(4), 354-364.

Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good interdisciplinary team work. Human Resources for Health, 11(19), 1-11. Web.

Nesse, R. E., Kutcher, G., Wood, D., & Rummans, T. (2010). Framing change for high-value healthcare systems. Journal for Healthcare Quality, 32(1), 23-28.

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