Inverting the organisational pyramid

In any healthcare institution, the most important people are patients and their families [1]. These people benefit from the services of the institution, pay for these services either directly or indirectly through third-party payers, and hence affect the marketing of the institution through expressions of satisfaction (or dissatisfaction) with the services. They also form a customer base for receipt of present and future services from the institution. A bond between an institution and its customer base of patients and families is essential to the survival of healthcare institutions and fulfilment of their mission as a public asset. In an organisational chart that depicts the fulfilment of an institution's mission, patients and their families would be given " top billing " because they are the sole reason for the institution's existence. Within an institution, the most important employees are those who provide healthcare services to patients and supportive services to families. These persons include the nurses, technologists, orderlies, receptionists, and others who interact directly with patients and families through the provision of healthcare either directly or indirectly. These are the individuals who are fulfilling the mission of the institution, providing safe and effective healthcare services, gaining the support of patients and families for the institution, and thereby assuring the success and longevity of the institution. In cases where physicians are institutional employees, they would be included in this list of caregivers. All of these individuals should be positioned on an organisational chart directly below patients and their families because they are the conduit for the flow of services to patients and families (i.e. they are responsible for assuring the institution's present and future customer base). Employees who provide services to patients and families need resources and an institutional infrastructure to help them fulfil their responsibilities to patients and their families. This infrastructure includes administrative personnel who can ensure the flow of necessary resources to the employees providing services to patients. There may be multiple layers of administrative personnel. Those working most closely with the healthcare providers (the " sub-sub bosses ") constitute the top tier of administrative personnel, those who support these individuals (" the sub-bosses ") comprise the second tier, and at the bottom is the person who has the job of assuring that all of the employees above him or her have the resources and support necessary to do their job. This person is " the boss " , …