Veterans Administration Medical Center-Structure and Culture


Obtain a nursing organizational chart for your agency, department, or service area.

Write a 1,050- to 1,400-word paper in which you address the following:

  • Identify the type of organizational structure.
  • How does the structure create an environment of support for client-centered care?
  • Discuss the use of information systems, communication methods, and a decision making-ability with culture and organizational structure of the agency.
  • Obtain an organizational chart from your health care setting and prepare to discuss the various lines of communication and reporting. Identify what you observe to be the formal and informal reporting lines and look at issues of power and control, as well as whom the real leaders in this organization are. How are the social and cultural influences of your community integrated into the delivery of care in your organization?
  • How do generational differences influence the organizational culture of the workplace?


Veterans Administration Medical Center-Structure and Culture

Type of organizational structure

Veterans Administration Medical Center (VAMC) uses a matrix organizational structure. A matrix organizational structure combines the element of functional and product organizational structure. In a functional organization, departments are divided as per their functions. In divisional structures, the departments are divided based on customers served or the type of services and products offered. The functional units are headed by departmental heads. Employees are supposed to report to the departmental heads of any challenges they meet in addition to work progress. Matrix organizations are collaborative in nature in that they encourage the members to share information. Thus in matrix organizations, horizontal as well as vertical channels of communication must remain open.

VAMC hospital is divided into 6 departmental units based on the nature of services provided. Each of these units is headed by a Chief Nurse. The 6 units include: ambulatory care, mental health, acute care, long-term care, chaplain service, and rural health. Each of these units are further narrowed down to the specific services provided. For example, the acute care division is subdivided further into ICU, tour coordinator, and among others. All Chief Nurses report to an Associate Director in charge of patient care services. Immediately under the Chief Nurse, various persons are identified based on hierarchical levels. For instance, the highest in each level is a Registered Nurse Manager followed by a Registered Nurse, Licensed Practical Nurse and then Nursing Assistants.

How the Structure creates an environment of support for client-centered care

The matrix organizational structure at VAMC enhances easy information sharing among various units. Information can flow both vertically and horizontally.  A matrix organizational structure is most appropriate in organizations which have high interdependencies between various products or services (Kerzner, 2009). This enhances easy retrieval of patient information such as medical records or laboratory reports. A matrix organizational structure also enhances flexibility and better coordination among various departments. This is because each department is charged with a particular duty of care towards the patients. As such, each department handles a particular role which does not overlap with the role of other departments. It also enables better reactivity to client needs. Various departments provide specific patient care depending on patient characteristics. For instance, the mental health segment caters to those with mental problems. This ensures better reactivity to their needs.

According to Kerzner (2009), matrix structure also creates an environment of support for client-centered care by ensuring minimal resource use. Effective use of resources at the hospital translates to lower hospital bills to patients enabling them to afford quality care. A matrix structure in hospitals eliminates duplication of work effort leading to high efficiency. It also minimizes the under-utilization of various resources at the hospital. This ensures an easy patient process that is cost effective to both the patients and the hospital as well. In a matrix structure, various personnel are aware of the role they play in delivering patient care. This helps to avoid conflicts and to provide smooth and quality care to patients.

Use of information systems, communication methods and a decision-making ability with culture and organizational structure of the agency

The use of information systems have become integrated in modern hospitals. Information systems have helped in documentation and easy retrieval of patient records or data. The use of information systems have enhanced the improvement of health care delivery in most hospitals. A key feature with application of information systems is the centrality of information. This has enabled easy sharing of information between nurses, patients, and the entire organization. The use of information system still maintains the hierarchical structure in an organization. In communication, the management establishes official channels of communication through the use of information systems. For instance, a Registered Nurse can pass official communication to the Chief Nurse through the official organization email.

Organizational chart and lines of communication

There are different lines of communication and reporting at VAMC. Vertical and horizontal lines of communication and reporting are the most common in the hospital (Cole, 2004). Vertical communication is a type of communication that occurs between persons who have different hierarchical status in the hospital. The flow of information may either be upwards or downwards. Downward communication is the most common in the organization. It involves the flow of information from the Chief Nurses to those in lower positions such as Registered Nurse Manager. This often involves directions of how work will be carried out. Upward communication occurs when those in lower positions communicate with others in higher positions such as Chief Nurses. It often involves giving reports of the day-to-day operations. Horizontal lines of communication involves staff in same hierarchical levels, for instance, communication among Registered Nurses.

Formal reporting lines involve using the official established channels of communication to pass messages. On the other hand, informal reporting lines involve all lines of communication which employees use but are not officially recognized by the hospital. Informal communication does not flow along hierarchical levels established in an organization (Cole, 2004). Formal reporting lines are clearly established between Registered Nurses and the Chief Nurses in all departments. Informal reporting lines exist among Registered Nurses, Licensed Practical Nurses and Registered Nurse Managers, the latter to some degree only. The real leaders in the organization are the Associate Directors. The social and cultural influences of the community is integrated by allowing a Chaplain to interact and pray for patients. The majority of people in the community and at the hospital profess the Christian faith.

How generational differences influence the organizational culture of the workplace

Generational differences have a significant impact on the culture of the workplace. Generational differences are brought about by age differences between older nurses and new nurses who are joining the profession. Due to shortage of nurses, most hospitals are retaining old nurses or hiring retirees. This have created a large generational gap. Generational differences often leads to different beliefs, attitudes, work habits, customs and experiences. These differences can at times create disagreements.  According to Sherman (2006), there are four generational cohorts in the workplace depending on year of birth. These include: Traditionalists, Baby Boomer generation, Generation X and Millennials. Each of them influence the organizational culture in different ways.

The traditionalists are those born before 1945. They highly respect authority and the hierarchical relationships in place. They are highly disciplined, cautious and hardworking. The Baby Boomers are those born before 1964. These tend to have strong work ethics. They are also hard working. They thus influence the organizational culture by instilling work ethics. The Generation X (1964-1980) also value good work ethics. The millennial Generation comprise of those born between 1980 and 2000 (Sherman, 2006). This category comprise of individuals raised in multicultural communities. They are thus good at embracing cultural and religious diversity at the workplace. This generation was also impacted by new technologies. As such, they are good at embracing the application of new and modern technologies in the workplace.

It is recommended that VAMC should come up with clear lines of authority and responsibility to avoid confusion among various individuals in equal positions of power. For instance, the Chief Nurses may conflict over responsibility and authority. This is one of the limitations of a matrix structure. It is also recommended that the health organization should establish training sessions for staff aimed at building a homogenous organizational culture.

In conclusion, the organizational culture and structure determines the quality of care accorded to patients. The organizational structure establishes the relationships and reporting lines among various individuals in the organization. The matrix organizational structure at VAMC enhances information sharing among personnel. The organizational culture influences how work is done in terms of discipline, commitment and observance of work ethics.


Cole, G. A. (2004). Management theory and practice. London: Thomson Learning.

Kerzner, H. (2009). Project management: A systems approach to planning, scheduling, and         controlling. Hoboken, N.J: John Wiley & Sons.

Sherman, R., (2006). Leading a Multigenerational Nursing Workforce: Issues, Challenges and Strategies. OJIN: The Online Journal of Issues in Nursing, 11(2): 3-15.

Nursing Process Improvement Research-HCS/492