A patient arriving at an emergency room and subsequently admitted will require team work involving many departments, such as: lab, radiology, admissions, registration, and the inpatient unit.  In...

A patient arriving at an emergency room and subsequently admitted will require team work involving many departments, such as: lab, radiology, admissions, registration, and the inpatient unit.  In discussing vertical versus horizontal structures, which does this type of organizational structure mimic? Also, with respect to cross functional teams, which is when staff from various areas work together on a part-time or full-time basis. This concept brings up another point worthy of consideration for future managers/leaders. The most frequent example is cross training of staff for this purpose. Cross training is valuable in that it creates flexibility to fit the needs of a given shift.

What other positive or negatives related to the expectation of cross training of staff can be identified?

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kipling2448 | (Level 3) Educator Emeritus

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Hospitals are structured both horizontally and vertically.  It is the rarest of businesses or organizations that is not primarily vertically integrated, as the top-down structure is necessary to ensure accountability and uniformity of mission.  Some organizations, however, like hospitals, must involve a great deal of horizontal integration in order to be effective.  Patients arriving at an emergency room are questioned and, if necessary, immediately examined so that the precise nature of the illness or injury can be ascertained and, if necessary, be treated without delay.  Obviously, this is primarily the case with life-threatening injuries or in cases where stroke or heart failure are suspected.  In such cases, emergency room physicians are prepared to take immediate steps, whether injecting blood thinners if stroke is suspected or incubating a patient to ensure the delivery of oxygen or to prevent a patient from experiencing aspiration and choking on vomit.  In any event, emergency rooms, as well as the broader medical facility, require a high-degree of horizontal integration so that, once initial, life-threatening symptoms are stabilized, the appropriate specializations can be brought to bear in the service of the patient.

At the same time, however, the hospital is vertically integrated inasmuch as senior-level physicians and administrators are ultimately responsible for what occurs within the confines of the facility and represent the highest levels of responsibility and accountability.  A vertical structure is required because there has to be a well-defined chain of command down from which direction comes and up in which inquiries and requests can be funneled. 

Cross-training has no negative aspects as long as all concerned recognize the limits.  There is an old saying, “Jack of all trades, master of none.”  Cross-training is important so that vital capabilities are never entirely absent.  At the same time, however, the more widely-spread a physician or medical technician’s training, the less specialized he or she becomes.  As specializations exists to ensure the best care can be provided for specific conditions, the levels of expertise demanded of specialists far exceeds what can be attained through even the most rigorous program of cross-training.  Medical students during their internships or residencies decide on the precise field of medicine in which they hope to specialize.  Prior to the point, they are educated in all elements of medical care so that they fully understand the intricacies of and relationships within the human body, such as the way in which the respiratory system functions and how it interacts with the cardiovascular system.  In this respect, they complete their medical school education already “cross-trained.” 

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