The contention of Kreitner, (2002, pp.295) is that there needs to be a degree of flexibility in the organizational structures of today to allow for “environment interaction”, which are more adaptable to sudden changes. This no doubt is a feature which the more traditional hierarchical models do not accommodate. The conclusion which Kreitner arrived at, suggests that organizations seeking to maintain a competitive advantage in the current environment would do well to embrace an organizational structural approach akin to a “contingency” model. It would be useful at this point to indicate that studies regarding the use of the contingency model, dates back as far as work done by Lawrence & Lorsch (1967) in which analysis done recognized that changes in the external environment influenced changes in the internal environment, and these all impacted upon the “integrating mechanism of the organization” (Lawrence & Lorsch, cited in Lee, et al.1982). What is purported in the fore mentioned research is the recognition that (1) the contingency model allows for management to organize work in a manner reflective of the environmental uncertainty and (2) The summation that there is no single best way to structure an organization (Kreitner, 2002, pp.295).

The central issue therefore which seem to be at the heart of the literature regarding organizational structure and HR functioning is the need to ensure that the organizational structure is not restrictive or cumbersome to the efficient implementation of policies and the running of the organization.   Research done by Kumar et al. (2010) points to the fact that traditionally in smaller organizations  there was little use of a specific Human Resource Management department or a Human Resource manager for that matter. This is further compounded by the fact that the HR function was not properly organized as well.  The findings of Kumar et al (2010) in a study of thirty (30) small hospitals in the state of Rajasthan India revealed that fifteen (15) of those hospitals employed an administrator who held responsibility for general management as well as the management of human resource.  Only three of the thirty hospitals actually used the term HR manager as a designated post and responsibility in the organizational structure.  A rather interesting observation is made in the fore mentioned study as well, in which it was indicated that a number of professional doctors with little or no training or exposure to management, were actually responsible for the administration of the HR function.   It must be noted that there is also another perspective to this matter which has been expressed by other researchers such as Laouer (2011), regarding the fact that too often the decision makers are non- medical persons who are unfamiliar with the rapidly changing demands of health care. The question however which begs to be answered is whether the absence of medical professionals on a health sector management team is a significant disincentive to its success?

It is however postulated by Laouer (2011) that more and more physicians are playing active roles in the management of hospitals.  A case in point is that of the boards in French hospitals.  According to Laouer, “previously, French University Hospital Centers (UHCs) were governed by a single board of directors, but the recent introduction of new legislation has introduced a two-tier structure comprising supervisory and management boards; the latter replacing the office of Chief Executive.”(Laouer, 2011).  This new arrangement sees the establishment of a supervisory board of physicians, patients and local authorizes, functioning as a first- tier management structure.  At a second tier there is a management board of administrative managers and physicians.   What therefore must be examined is the fluidity or lack thereof in the implementation of HR policies based on the type of management structure which exists in the organization.   An interesting model of hospital management emerged out of a study done by Schepers (2006) in which an examination was done of two Belgian hospitals on the relationship between doctors and management.  What was evident in this study was that the system which exists in one of the two hospitals studied saw a hierarchy of management which includes a medical council which is an advisory body, and a disciplinary council called the ‘Order of Physicians’.  While the management of the hospital came under the purview of a medical management team, additionally, self-regulation by doctors is a critical component of the management policy of the hospital.  A significant deficiency of this particular study, however, is the absence of empirical findings on the effectiveness of a self-regulatory policy, which from a cursory perspective leaves much room for medical and ethical malpractices in such a volatile sector. The author recognizes that there is need for greater examination into the efficacy of a self- regulatory policy in health care delivery.  The conclusion however which must be drawn, and which is also supported in arguments by Little (1986), Oliver (1997), and Caudron (1993) is that as the size of the hospital increases, the need for a structured and formal HR function is of absolute necessity