Organizational Structure

Organizations exist to achieve goals. These goals are broken down into tasks as the basis for jobs. Jobs are grouped into departments. Within each department, even more distinctions can be found between the jobs people perform. Departments are linked to form the organizational structure.
Organizational structure refers to the formal configuration between individuals and groups regarding the allocation of tasks, responsibilities, and authority within the organization. The essence of organizational structure is the division of work among members of the organization, and the coordination of their activities so they are directed towards the goals and objectives of the organization.
The organizational structure affects organizational action in two ways. First, it provides the foundation on which standard operating procedures and routines rest. Second, it determines which individuals get to participate in which decision- making processes, and thus to what extent their views shape the organization’s actions.
The structure of an organization is usually depicted in the form of an organization chart. The Chart shows, at a given moment in time, how work is divided and the grouping together of activities, the levels of authority and formal organizational relationships. The main purpose of an organization chart is to show the hierarchical structure, or chain of command within an organization.
The organizational structure of the Hospital facilitates the understanding of the Hospital’s chain of command and also shows which individual or department is accountable for each area of the Hospital. The organizational structure of the GARH is presented in the Chart in Figure 4. The chart provides a pictorial representation of the overall shape and structural framework of the Hospital. The Medical Director is the Chief Executive and the top boss responsible for everything that goes on in the Hospital.
The Medical Director has overall corporate responsibility for the development of the Hospital’s organizational strategy and the implementation of MOH/GHS policies in the Hospital. In the performance of his functions, the Medical Director is answerable to the Director General of GHS, through the Regional Director of Health Services. The exercise of authority and responsibilities by the Medical Director is derived from and consistent with the GHS Act, 1996 (Act 525) section 29 (1) as well as authority and responsibilities delegated by the immediate superiors.
Directly under the Head of the Medical Director are the Heads of the five main Directorates of the Hospital, i.e., Heads of Clinical Care, Nursing Services, Pharmaceutical Services, Health Administration & Support Services (HASS) and Finance & Accounts Directorate. The Heads of these five Directorates act as the line managers, but with interlocking working relationships. Each Directorate Head reports directly to the Medical Director in his /her day-to-day administration of the Directorates. The Heads of the Directorates exercise authority as derived from and consistent with their responsibilities as well as authority delegated by their immediate superior (Medical Director of the Hospital). In effect, the Heads of the Directorates are directed, guided and accountable to the Medical Director of the Hospital.
The Heads of the five Directorates together with the Medical Director form the Core Hospital Management Committee (CHMC) and are responsible for the day-to-day administration of the respective Directorates, with the Medical Director exercising overall supervisory responsibility over the divisions of the Hospital.
A Department is the next level to the Directorates and a Unit is a section within a Department. Under the current arrangement in the Hospital, only one Division i.e. Clinical Care Directorates has both Departments and Units under it. The rest of the Directorates i.e. (Nursing Services, Pharmaceutical Services, Administration & Support Services, Finance & Accounts Directorates) have only Units under them.

Each department under the Clinical Care Directorate is headed by a Department Head and reports directly to the Head of Clinical Care. Under the departments, there are also Units. The Units have heads who are accountable and report directly to Department Heads. Apart from the Clinical Care Directorate, the rest of the directorates, as earlier stated, have only Unit Heads and they report directly to the Directorate Heads.

The Internal Audit Unit is independent of the Administration and performs independent auditing functions. The Unit is directly responsible to the Hospital House Management Committee and indirectly to the Medical Director.

Operational Committee

Committees are groups of persons formed internationally and to whom specific tasks have been assigned (Willan, 1990). Committees are one of the several governing tools used by management to share authority across an organization to stimulate interest in decision-making. Participative management utilizes committees or working groups with clearly defined terms of reference as a tool to achieve the overall organizational goals. With committees, members function collectively and responsibility for decisions is spread among several persons. Committees thus offer the opportunity for group problem solving and serve as a forum for presenting multiple points of view. This helps to safeguard against the tendency of power and authority being centralized among few persons.

Committees are an integral part of the operations of the public-sector health institutions in Ghana. At GARH, there is a statutory Hospital House Management Committee (HHMC) which assists the Medical Director to formulate policies towards the management of the Hospital. The HHMC is the highest Decision-Making Body and supports the Medical Director to implement government policies (i.e. GHS Council, MOH / GHS/RHD Policies) and also formulate and implement internal local policies and operational strategies in the hospital.

The Divisions

  • Clinical Care
  • Pharmaceutical Services
  • Nursing and Midwifery Services
  • Finance & Accounts Services
  • Health Administration & Support Services

The membership of the HHMC comprises:

  • The Medical Director
  • The Head of Clinical Care
  • The Head of Administration & Support Services
  • The Head of Pharmacy
  • The Head of Nursing & Midwifery Services
  • The Head of Finance & Accounts Services
  • The Heads of Clinical Departments
  • Two representatives of Unions/Professional Associations in the Hospital
  • A representative of Accra Metro Health Services

The Medical Director is the Chairman of the HHMC while the Head of Administration and Support Services acts as its Secretary. The HHMC is required to meet once every month or at least six times in a year to conduct its normal business. In case of any special event, the committee is required to convene an emergency meeting to resolve that particular issue. The quorum at a meeting of the Hospital Management Committee is the majority of the total membership.

Apart from the HHMC, there is also a Core Hospital Management Committee made up of the Medical Director and the Heads of the five main Division or functional areas of the Hospital, i.e.
  • The Head of Clinical Care
  • The Head of Administration & Support Services
  • The Head of Pharmacy
  • The Head of Nursing Services
  • The Head of Finance & Accounts Services
This Committee meets once in a week (every Monday) to take stock of the activities of the Divisions in the preceding week, develop strategies to address the challenges that emanate therefrom and chart the way forward for the current week. In addition to the HHMC, a number of Sub-Committees have been set up to handle relevant issues referred to them by the Hospital Management. The recommendations of all Sub-Committees are advisory. The management reserves the right to implement recommendations of a Committee as it is or vary it. Depending on the nature of an issue, Management can decide to handle it directly without referring to the relevant committee. The membership and the terms of reference of the various Sub-Committees set up in the Hospital are spelled out as indicated below:

Operational / Sub-Committees at GARH

Operational Linkages of the GARH

Within the framework of MOH/GHS, the GRAH reports administratively to through Regional Health Directorate to Office of Director General (GHS headquarters) to GHS Council and to MOH. Functionally, the GARH is an integral part of the Greater Accra Regional Health System. The Hospital reports to the Regional Coordinating Council (RCC) through the RHD. The Hospital also reports to Metro Health Directorate in terms of service statistics. The GARH also serves as a referral center for Municipal and District Hospital within GAR and also provides technical supervision over the lower facilities in the region. The operational linkages in terms of administrative and functional linkages of GARH are presented diagrammatically in the Figures below:

Functional Linkages

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