Hospital org chart example
A community hospital of a few hundred people, drawn around the fact every hospital chart has to admit: there are two lines of authority. The administration runs the building; the medical staff, accountable to the board rather than the chief executive, governs the practice of medicine in it. Nursing, the largest workforce, sits beside the medical officer and not beneath him.
How a hospital is usually structured
The top is a board of trustees, and the chart needs it because two lines run to it. The chief executive runs the hospital's administration: a chief medical officer for the employed physician side, a chief nursing officer for nursing, a chief operating officer for the ancillary and support departments, a chief financial officer, a chief information officer and a chief human resources officer. That half looks like any company.
The other half does not. The medical staff — the physicians with privileges to practise in the hospital, many of them not employees — is a self-governing body with its own bylaws, its own elected officers and its own committees, and it is accountable to the board, not to the chief executive. Its chief of staff, or president of the medical staff, reports to the board and keeps a dotted line to the chief executive. A hospital that draws the medical staff under the chief medical officer has drawn something its bylaws say is not so, and an accreditor will notice.
Below the executives, the hospital is departments, and they are large. Nursing alone will have a director for every service — medical-surgical, critical care, the emergency department, surgical services, women's and children's — with nurse managers and charge nurses beneath, so the chart shows directors and stacks them. Ancillary and support — laboratory, imaging, pharmacy, rehabilitation, facilities, environmental and food services — sits under the chief operating officer. Quality and patient safety, and compliance, report to the chief executive with dotted lines to the board's committees, because the board is answerable for both and needs to hear from them without the administration in between.
Typical titles by level
The vocabulary these charts use, from the top down. Titles vary by country and by company; the levels don't.
| Level | Titles you'll see |
|---|---|
| Governance | Board of Trustees or Directors, Quality Committee, Finance Committee, Medical Executive Committee, Chief of Staff or President of the Medical Staff |
| Executive | President & Chief Executive Officer, Chief Medical Officer, Chief Nursing Officer, Chief Operating Officer, Chief Financial Officer, Chief Information Officer, Chief Human Resources Officer, Chief Compliance Officer, VP Quality & Patient Safety |
| Directors and managers | Nursing Director, Nurse Manager, Medical Director (Hospital Medicine, Emergency, Surgery), Department Director (Laboratory, Imaging, Pharmacy, Rehabilitation, Facilities), Practice Manager, Revenue Cycle Director, Health Information Management Director, Infection Prevention Manager, Risk Manager |
| Staff | Charge Nurse, Registered Nurse, Licensed Practical Nurse, Nursing Assistant, Physician (employed or contracted), Hospitalist, Resident, Physician Assistant, Nurse Practitioner, Pharmacist, Technologist, Therapist, Unit Clerk, Environmental Services Technician, Food Service Worker |
Where these charts go wrong
Hospital charts go wrong by drawing the medical staff under the chief medical officer; by putting nursing under the medical officer; by folding quality into operations, where a budget can quiet it; by leaving the contracted physician groups off, so the emergency department appears to have no doctors; and by charting every unit and every shift until the document is a hundred pages that the accreditor reads and the staff never do.
Questions people ask
- Who does the chief of staff report to in a hospital?
- The board. The chief of staff, or president of the medical staff, is elected by the medical staff under its bylaws and is accountable to the board of trustees for the quality of medical practice in the hospital. The chief executive is a working partner, drawn as a dotted line, not the boss. The chief medical officer, by contrast, is an employed executive and does report to the chief executive.
- Why does the chief nursing officer report to the chief executive rather than the chief medical officer?
- Because nursing is a profession with its own practice, its own standards and, in most hospitals, its own largest budget line. The chief nursing officer manages more people than anyone else in the building and sits at the executive table as a peer. A chart that draws nursing under medicine describes a hospital from before nursing had its own leadership, and offends most of the people in it.
- Where do contracted physician groups go on the chart?
- Under the medical director or executive who holds the contract, as a contractor card for the group, with the group's own lead named if the chart is for the department. The emergency department, anaesthesia, radiology and hospitalist services are frequently contracted, and a chart that omits them shows departments with no physicians.
- How do you show service lines on a hospital chart?
- As a dotted line from the service-line director to the departments that contribute to it. A cardiology service line draws on cardiology, imaging, surgery and nursing, none of which report to it. The solid lines stay with the departments that hire, pay and evaluate people; the service line is the matrix laid over them, and the chart should say so rather than pretend the departments moved.
Other industries
- ManufacturingTwo shifts, and quality kept out of production's line.
- LogisticsDispatch runs the day; supervisors run the people.
- ConstructionOffice and field, meeting on every project.
- Software startupSquads under a CTO; product managers on a dotted line.
- NonprofitThe board on top, programmes beside the money.
- Medical practiceA clinical line and a business line, crossing at nursing.
- SchoolDepartments led by teachers who also manage.
- HotelSix divisions around one general manager.
- Marketing agencyDisciplines own people; pods own the work.
- Security & facilities servicesSites stacked under supervisors; a 24-hour control room.
- Sales teamRegions for closers, a team for openers, RevOps beside them.
- Accounting firmA partner pyramid, three service lines.
- Law firmPractice groups, and the business side that runs the firm.
- ChurchA board that governs, a pastor who leads, ministries below.
- RestaurantFront of house and back of house, meeting at the pass.
- IT departmentRun, build and secure, under one director.
- HR departmentPartners, specialists and operations: the three legs.
- Local governmentElected above appointed, and two officers who answer to the council.
- Utility companyField crews, a 24-hour control centre, and a regulator in the room.
- BankThree lines of defence, drawn as lines.
- Staffing agencySales desks, recruiting desks, and a back office that pays two thousand people.
- Retail chainHead office, the field, and a store drawn once.
- Small businessOne owner, two managers, and the jobs the owner still does.
Or start from a structure — functional, divisional, matrix or flat — or from your own spreadsheet. The guides cover a reorg, a merger, an assistant's chart and a consultant's deliverable.
Make it yours
Download the spreadsheet, replace the names, import it — the chart redraws itself. Or start empty and drag people until it's true. Building is free at any size.