I The formal organization (by G. Houwink)

The Provinciaal Ziekenhuis Santpoort — a 1100-bed psychiatrie hospital founded in 1849 — started an organizational change 4 years ago, mainly because the traditional hierarchical structure hampered severely communication and coordination of the common goals of treatment, making it little efficient in many ways.
In the traditional organization the hospital was subdivided into a number of wards, all doing the same kinds of treatment without any coordination of tasks. Workers on the wards had great influence on the patients that were treated, but little or none on the process of decision-making on their work, still they were greatly critizised by Society. Society demands better treatment and clarification of expenses which could not be given because no objectives of treatment had ever been formulated. The directors of the hospital on the other hand had no influence on what was actually going on on the ward. The new organization has 3 main principles; the active participation of all workers in the decision of the hospitals' policies, the delegation of responsibilities of the work done to the basis and the promotion of a management-attitude towards treatment by continious evaluation. A description is given of the overall structural model of the new organization, in which stearing groups formulate the overall policies and management teams are responsible to carry out the decislons made.