Introduction
An organizational design specifies and describes the formal and the informal structures and processes within an organization through which the organization pursues its mission and objectives. An organizational design, thus, is the framework within which an organization functions. Both internal forces and external forces influence the character of an organization’s design. An organizational design tends to be defined in terms of structure, processes, and size (Chatain & Zemsky, 2007; Knoll, 2007; Zismer, 2011). The findings of a description and an assessment of organizational design of a group practice family medicine clinic are presented in this paper. The description and assessment include the identification of the internal forces and the external forces that have influenced the nature of the organizational design of the clinic. The effects of these forces on organizational structure, organizational processes, and organizational size are addressed in the paper. Specific consideration is given in the discussion to the effects of accountability mandates on the organizational design of the clinic.
The Internal Forces and the External Forces Affecting the Organizational Design of the Clinic
The external forces that act on the organization in this case, a group practice family medical clinic, exerted a greater effect on reshaping the organizational design of the practice than has been true of the internal forces that also drive changes in organizational design. The two most important external forces, when considered in relation to effects on organizational design, have been, in the opinion of this writer, (a) technological innovations that directly affect the acquisition, presentation, interpretation, access, and storage of patient-related information, and (b) the accountability movement in health care delivery in the United