Izzivi prihodnosti / Challenges of the Future, Članek / Article Avgust / August 2022, leto / year 7, številka / number 3, str. / pp. 164–181. * Korespondenčni avtor / Correspondence author 164 Prejeto: 12. junij 2022; revidirano: 3. avgust 2022; sprejeto: 22. avgust 2022. / Received: 12th June 2022; revised: 3rd August 2022; accepted: 22nd August 2022. DOI: 10.37886/ip.2022.008 Perception Levels of Employees’ Organizational Performance in a Healthcare Organization Siniša Jolić* Department of Dermatovenereology and Angiology, “Kikinda General Hospital“, Đure Jakšića 110, 23300, Kikinda, Republic of Serbia drsinisajolic@gmail.com Slobodan Mirosavljev M.D.FACS International SOS-medical director slobodan777@yahoo.com Vesna Turkulov Infectious Diseases Clinic; Clinica Center of Vojvodina; Hajduk Veljkova 1-9, 21000 Novi Sad, Republic of Serbia vesna.turkulov@mf.uns.ac.rs Jovan Jolić Student at the Faculty of Mechanical Engineering of University of Novi Sad and student of Management Faculy of the University »Union-Nikola Tesla«, Cara Dušana 62-64, 11158 Belgrade, Republic of Serbia jovan.jolic@gmail.com Slavica Mitrović Veljković Faculty of Technical Sciences, University of Novi Sad; Trg Dositeja Obradovića 6, 21000 Novi Sad, Republic of Serbia mslavica@uns.ac.rs Jelena Raut* Faculty of Technical Sciences, University of Novi Sad; Trg Dositeja Obradovića 6, 21000 Novi Sad, Republic of Serbia jelena.raut@yahoo.com Abstract: Background and Originality: The subject of the research is the definition and analysis of the process of organization in a health organization, as well as the perception of employees in terms of performance of the organization. The aim of the research is to determine the manner of organizing, i.e., the phase in the process of designing the organizational structure in the health organization, as Izzivi prihodnosti / Challenges of the Future, Članek / Article Avgust / August 2022, leto / year 7, številka / number 3, str. / pp. 164–181. 165 well as to determine the level of perception of organizational performance of employees in that organization. Method: The subject research was conducted through a standardized questionnaire (Griffithsetall, 2006), which contains 8 questions related to the basic demographic data of employees and 30 questions related to the subject of the research. Results: Proving research questions and hypotheses in the research leads to the conclusion that clearly defined roles and responsibilities, the existence of an appropriate pace of work, deep understanding of the wishes and needs of patients by employees and employee motivation to work affect the success of a health organization, that is, the manner of organizing affects its business success, while the work environment is not one of the factors that affect the success of a health organization. Society: Considering the impact on society, through the defined measures proposed above, this research paper proposes a way to preserve the functioning of a health organization, meet the wishes and needs of patients and preserve one of the basic human needs, and that is the right to an adequate treatment. Limitations / further research: The proposal for future research is reflected in increasing the sample of examinees and repeating research in health organizations across the country. Keywords: health organization, organizational structure, organizational structure design, perception of organizational performance, manner of organizing. 1 Introduction Organizing is a managing activity based on allocating jobs to certain groups of employees within a company. Williams (2011, p. 1348) says that therefore create an atmosphere of specialized groups and individuals responsible for certain kinds of jobs and in that way increase the efficacy of business which contributes to better decision making. Griffiths (2006, p. 677) says that the goal of organizing is to make an adequate organizational structure which encompasses activities and relationships, and when it is formed it is necessary to manage human resources in the proper manner to do successful business in the long run. Modern approach of organizing sees organizing as a collection of resources and abilities, which as its goal have the creation of key competencies. Jones et al.’s (2007, p. 142) understanding the way in which organizations perform their business activities is the first step in learning how to control and change organizations so that they can effectively create new resources. As can be seen in the study Cox et al.’s (2003, p. 184), managers and employees who possess the knowledge about organizational design and changes can analyse the structure and culture of the organization in which they work, of diagnosing problems and of adapting, for the organization to reach its goals. The process of organizing differs in cases if the organization is just being founded, or if it already exists in the market, in which case only a reorganization is done. Managing function is a necessary function in every company today, and therefore it is becoming more and more important in healthcare institutions too. As Ferguson (2003, p. 87) states, when considering and researching health management, it must be said that it developed relatively late compared to general management because it had Izzivi prihodnosti / Challenges of the Future, Članek / Article Avgust / August 2022, leto / year 7, številka / number 3, str. / pp. 164–181. 166 not succeeded completely in solving numerous dilemmas which were consequences of certain theoretical and conceptual discords. When it comes to healthcare management, or rather, healthcare system management, the management health institutions or health programs, projects, and health teams, next to general principles of management, it is also very important to consider all the specificities of working within a healthcare system. One definition cited by Dovijanić (2003, p. 26) that considers all important elements of a healthcare system states that healthcare management can refer to the sum of all measures undertaken to plan, organize, implement and evaluate many elements integrated into the healthcare system, where measures are needed in order for the healthcare policies to become strategies, strategies to become plans/actions, so the action needed for decision making concerning implementation of healthcare programs could be determined and thus enable the healthcare infrastructure to develop in such a way as to provide efficient and effective implementation of a healthcare program. A Cox (1993, p. 98; 2000, p. 37) states in his research, failures of work design and management are known to challenge both employee health and organizational behaviour and the healthiness and performance of the organization. Such failures are often referred to as “work and organisational factors”. In the occupational health literature and are the focus of much attention in relation to the assessment and reduction of work-related risk at both the individual and organizational levels. Employee satisfaction is considered weighty when it comes to defining organizational success. Employee satisfaction is a central concern. Naseem et al. (2011, p. 52) argue that the need to increase employee satisfaction is critical because it is key to the business success of any organization. It is very important to observe the relationship between employee satisfaction, both in other sectors and in the health sector and examine the impact of employee satisfaction on organizational success. The subject of this research paper is defining and analysing the organization process in a healthcare institution, as well as the review of employees’ perception considering the organizational performance. The goal of the research is determining the manner of organizing, or rather the phase in the process of designing an organizational structure within a healthcare institution, as well as establishing the perception level of organizational performance of the institution’s employees. Based on the defined goal and subject of the research, one hypothesis has been established: H – Organizational manner affects the success of a healthcare institution business. As healthcare management, or rather manner of organizing has a very specific and fixed responsibility for a good functioning of healthcare system and its parts, it can be concluded that the greatest responsibility for implementing the determined tasks on all levels of healthcare system falls on managers. That is in fact the main reason of defining the general hypothesis the way it was defined above. Izzivi prihodnosti / Challenges of the Future, Članek / Article Avgust / August 2022, leto / year 7, številka / number 3, str. / pp. 164–181. 167 2 Theoretical starting points It can be claimed that healthcare management is highly developed nowadays. In the more developed countries, healthcare system is starting to be looked at as a healthcare industry, having in mind certain similarities with industry, such as building complexes, staff, and equipment concentration and so on. For observing the development of healthcare management, next to observing the development of general management (theories, principles, schools), it is needed to track all that affects the development of healthcare management in certain institutions, like the manner of organizing in a healthcare institution, work pace, the understanding of needs of patients, work environment and management support. For the observing of healthcare management to be as adequate as possible, it is suggested to begin with its definition, goals, and functions. Mićović (2008, p. 58) defined healthcare management as a process which includes planning, organizing, directing, controlling, and coordinating of resources, as well as the development of healthcare system based on the participation of the community and on health needs of people, to improve and better patients' health. In Brouwer et al.’s (2002, p. 182) context, healthcare management is basically a system of functions and tasks, implemented by individuals, on various levels of organization, with the goal of better health of the patients. In recent years, there have been two important shifts in perspective. First, research in occupational epidemiology has shifted its focus from the influence of ill health on absenteeism and returns to work toward its impact on performance, with a corresponding focus on the assessment of work-related health. Second, according to the author Black (2008, p. 47) indices of morbidity and mortality have shown that in general work is good for your health and well-being. For this reason, there is a great emphasis on adequate management and organization within health institutions. It is a fact that employee satisfaction is the deepest care in a sector such as healthcare. It is a multifactorial construct. Employee satisfaction includes basic factors, learning factors and performance factors. According to the author Matzler (2007, p. 1097), the main factors are minimum requirements that cause dissatisfaction thrill factors increase satisfaction only when performance ih high. Employee satisfaction plays a significant role in improvement operational performance organization and quality of the services they provide. There is no doubt that employee satisfaction is key to achieving quality and profitability, especially in the service industry. Yee et al. (2010, p. 114) say that employee loyalty is an important factor for improvement quality of services that are interconnected with the client customer satisfaction and loyalty and gives progress to make the company profitable in the industry. An imperative relationship exists between the employee and organization. This employee organization relationship plays important role in the success of any organization. Has the need for development in it. Managers are believed to develop role relationship in which actions and decisions should are promoted by interest organizations. Employee involvement and contribution to the organization is the result of interest. Coyle-Shapiro et al. (2007, p. 173) Izzivi prihodnosti / Challenges of the Future, Članek / Article Avgust / August 2022, leto / year 7, številka / number 3, str. / pp. 164–181. 168 says that the quality of employee relationship organization demands fulfilment of needs, quality of interaction, comfort, and identification. Employee satisfaction is job satisfaction. Job satisfaction is an important factor in work organization. Both of you they are significantly related. Therefore, Dawal et al.’s (2009, p. 3) claim that it is necessary to maintain job satisfaction so that employees can be motivated. In the study of job satisfaction, job rotation, work methods, problem solving, and goal setting are important factors to consider that job satisfaction is also influences by employees age, marital status, and work experience. According to Shi et al. (2022, p. 35), differentiation of individual employment characteristics can affect how employees feel about their job environment and the relationship between employee satisfaction and financial performance may not be easy noticeable because the customer conforms to it satisfaction. As previously stated, the goal of the research is determining the manner of organizing, or rather the phase in the process of designing the organizational structure in a healthcare institution, as well as determining the level of perception of organizational performance of the institution's employees. Modern approach to organizing considers organizing to be the sum of resources and abilities, which as a goal have the creation of key competencies. Like Peteraf (1993, p. 57) says, in today's theoretical approaches an idea was created of a unique group of resources and abilities and their organizational transformation, primarily through the existing organizational design or redesign, and in that way the making of a competitive difference or a more efficient organization. The most important organizational principles according to Fayol, Godwin et al. (2017, p. 82) which are still applied today, are:  unity of command – it is necessary for every employee to receive orders from only one manager,  unity of goals – all employees should work toward achieving common goals,  command range – talks about the number of employees governed by one boss,  hierarchy – there must be an order which regulates authorities concerning management,  centralization – there is a designated manager with all the competencies on every step of the hierarchy ladder,  authority – the main characteristic of every manager should be authority. The detailed distribution of work defines work tasks beginning with every single worker, then, based on the similarity of jobs and common work tasks, they are organized into work groups, followed by organizational units, the range of duties and authorities is defined, a hierarchy is constituted and in that way a picture of the organizational structure of an organization is created. Human resources are the most important element of every organization, as well as their attitude towards the organization, work means and their interpersonal relationships. More and more importance is given to motivation and satisfaction of employees, as well as to the effort of identifying individual goals with the goals of the Izzivi prihodnosti / Challenges of the Future, Članek / Article Avgust / August 2022, leto / year 7, številka / number 3, str. / pp. 164–181. 169 organization, by uniting people, having them work together and trying to actually achieve business success. The function of organizing is important for every company, and same goes for the healthcare system. The function of organizing does not end with defining the organizational structure, it is necessary throughout the life cycle of a company, primarily because of the dynamics of modern business. It is very complex and demands great responsibility of those who participate in its creation, more precisely the management of the organization, or rather the management of the healthcare system. According to the Mašić, et al. (2017, p. 65), the organizational structure represents the distribution of jobs within an organization. Managerial decisions related to the structural elements which change the organizational structure are called the designing of an organizational structure. Organizational structure is the means of achieving company's goals. It adjusts all the potential, or rather material and human resources, and points them towards a predetermined goal. The managers decide about organization design. The decision refers to the organizational structure which agrees with organization strategy and the environment in which the members of the organization will carry out the strategy. In this way, according to the Chan (2008, p. 49) organization design puts the managers in the position in which they have to simultaneously follow what happens within the organization, and what happens outside of it. For the organization structuring to be completed, it is necessary to know which jobs should be done. The task of the organization represents the starting point for analysis. Analysis begins with it and ends with its elementary parts. According to Olivares et al. (2022, p. 73), it develops in stages, beginning with single components and their dissection, to determining lower and more numerous single elements. According to the Mitrović and Melović (2013, p. 178), withing the organizational structure design, it is necessary to take care of the following activities:  Is the given structure defined so that it is directed towards the realization of the goals of the organization?  Are the resources necessary for the realization of goals used efficiently within a given structure?  Is the given structure flexible enough to adjust to new changes in the market?  Does the structure enable the improving of employees' knowledge?  Does the structure enable adequate informing and communicating? Managers make decisions about organization design. The decision refers to the organizational structure that fits the strategy and environment in which the members of the organization will realize the strategy. Hence design organization puts managers in the position in which they Izzivi prihodnosti / Challenges of the Future, Članek / Article Avgust / August 2022, leto / year 7, številka / number 3, str. / pp. 164–181. 170 have to simultaneously follow what happens within the organization, and what happens outside of it. 3 Method Cox et al. (2003, p. 195), say that failures of work design and management are known to challenge both employee health and employee’s health and organisational behaviour and the healthiness and performance of the organisation. For subject research, a standardized questionnaire was used by Griffithsetall (2006, p. 677). This instrument if referred to as the Work Organisation Assessment Questionnaire (WOAQ). The European Commission and the governments of most of the Member States of the European Union, have enacted programs to ensure that enterprises address the challenge posed by failures of work design and management and that they have the knowledge and tools to do so (ETUC). The approach adopted by the European Commission, and in Great Britain by the Health and Safety Executive (HSE), is based on an adaption of the traditional risk management paradigm for health and safety (Griffithsetall, 2006, p. 883). The SMS approach is based on the development of a standard questionnaire tool for the assessment of problems at work by employees in terms of perceived failures of work design and management which used by Griffithsetall (2006). It can be argued that the tool is most useful as a means of identifying »hot spots« in organizations and informing subsequent discussions between managers and other employees over the exact nature of those problems and reasonable ways of dealing with them. The questionnaire that was used in the subject research was translated into the Serbian language and adapted to it, in accordance with the prevailing cultural norms. Karimi et al. (2015, p. 323) state that the most common problems detected in the literature of full risk assessment were the facts that questionnaires are either very long and detailed or unable to detect the hazardous problem in a work setting. In response to the evidenced need for a short, valid stress risk assessment, WOAQ (Validity and Model-Based Reliability of the Work Organisation Assessment Questionnaire Among Nurses) was developed, which can be found in Griffiths et al.’s research (2006, p. 679). The methodology developed in WOAQ was based on the identification and collection of employee opinions on their work and health. The research was conducted in the health institution of secondary health protection in Vojvodina. The sample consists of 120 examinees. Questionnaires were distributed among the institution's employees, and to get the most objective results, the research also included employees from various sectors, that is from work units and different levels of organizational structure, from managers to executors. The questions were answered by health workers of all profiles and competencies and various medical specialties – specialists, subspecialists, resident doctors, general practitioners, nurses with bachelor's degree, trained nurses, as well as those employed in the managing unit, technical staff of the hospital and all else who perform jobs outside of field of medicine. The choice of employees who answered the questionnaire Izzivi prihodnosti / Challenges of the Future, Članek / Article Avgust / August 2022, leto / year 7, številka / number 3, str. / pp. 164–181. 171 was not formed according to a certain criterion; the research was done based on a random sample. The questionnaire has eight questions which relate to the basic demographic information about the employee and thirty questions which relate to the research subject. Next to every item there is a rating scale (Likert scale), with points 1-5, which are supposed to be circled, in accordance with the degree to which the examinee agrees with the stated claims. The scale is as follows: 1 - I do not agree at all, 2 - I mostly do not agree, 3 - I am undecided, I neither agree nor disagree, 4 - I agree, 5 - I completely agree. After the analysis of main characteristics of examinees, demographic, as well as educational and work status related, the examinees were supposed to answer 30 questions, created based on the Griffithsetall (2006, p. 679) questionnaire. Hereafter, the derived results will be presented. 4 Results Out of 120 examinees in the research, 15 % were male and 85 % were female. When it comes to the age of the examinees, 20 % of them belong to the group of 21-30 years old, 27 % belongs to the group of those who are 31-40 years old, 23 % of them belong to the group of 41–50-year-olds, 26 % belong to the group of 51–60-year-olds, and 4 % belong to the group of 61–70-year-olds. From those who participated in the research, 19 % of them have up to 5 years of service, 13 % have 6-10 years of service, 15 % have 11-15 years of service, 12 % have 16-20 years of service, 11 % have 21-25 years of service, 8 % have 25-30 years of service, 14 % have 31-35 years of service, and 8 % have 36-40 years of service. When analysing the examinees' education, the following result emerges: 67 % of them have only high school education, 11 % have an associate degree, 12 % have a university degree, and 10 % of examinees have finished their specialization studies, subspecialisation studies, have a master's degree or a PhD. Out of those who participated in the research, 19 % have had an education in the field of technical sciences, 68 % of them have an education in the field of natural sciences, and 13 % have an education in the social sciences. When analysing the time frame which shows how long the examinees have worked in the current organization, 6 % of them have worked there less than 6 months, 3 % of them have worked 6 months to a year, 8 % have worked 1-2 years, 13 % of them have worked 3-5 years, and 70 % of them have worked there longer than 5 years. When it comes to the status of the examinees in the organization, 25 % of them have been promoted within the organization and 75 % have remained at the same position in the organization. Looking at the managerial-organizational structure of the organization, according to the examinee sample, 4 % of examinees is on a higher level in the managerial-organizational structure (administrative management, chief physician, deputy chief physician, adviser, assistant), 16 % of them are at the middle level (technical manager, sector manager, office manager, head nurse), 6 % of them is on the lower level (department chiefs, head nurses od departments) and 74 % of examinees are not managers. Izzivi prihodnosti / Challenges of the Future, Članek / Article Avgust / August 2022, leto / year 7, številka / number 3, str. / pp. 164–181. 172 In continuation, results derived from the examinees' answers will be presented. For better visibility, the examinees' answers will be shown in Table 1, with stated claims and the degree of the examinees' agreement with the claim. Table 1. Examinees' answers analysis Claim 1 – I do not agree with the stated claim at all 2 – I mostly do not agree with the stated claim 3 – I am undecided, I neither agree nor disagree with the stated claim 4 – I mostly agree with the stated claim 5 – I completely agree with the stated claim 1. In the organization there are clearly defined rooms for breaks. 29 % 12 % 19 % 19 % 21 % 2. The work environment is motivating for work. 25 % 21 % 21 % 33 % 10 % 3. In the organization there are clearly defined roles and responsibilities. 8 % 7 % 32 % 31 % 22 % 4. During work hours there is exposure to physical danger. 18 % 22 % 17 % 26 % 28 % 5. In the organization there is support by the management. 15 % 18 % 30 % 28 % 8 % 6. The work pace is appropriate in the organization. 1 % 12 % 28 % 32 % 17 % 7. There is feedback as far as work performance goes. 8 % 16 % 38 % 26 % 12 % 8. The amount of work I have is acceptable. 18 % 9 % 23 % 31 % 19 % 9. In the organization there is a system of safety at work. 11 % 16 % 27 % 20 % 26 % 10. I get on well with my colleagues. 2 % 0 % 8 % 33 % 56 % 11. The employees appreciate the participation of the manager in monitoring the work done by the workers. 7 % 10 % 44 % 26 % 1 % 12. There are consultations concerning the changes at work. 8 % 12 % 31 % 32 % 17 % 13. I am prepared enough for my current job. 1 % 5 % 11 % 35 % 48 % 14. There is variety in the tasks I do. 5 % 3 % 10 % 35 % 47 % 15. There is influence of family/social life on the job. 16 % 17 % 27 % 24 % 16 % 16. The attitudes of higher management are felt on the job. 6 % 12 % 33 % 32 % 17 % 17. In the organization there are clear lines of reporting connected to work. 5 % 11 % 32 % 39 % 13 % 18. Equipment from IT sector that I use is adequate. 10 % 15 % 35 % 29 % 11 % 19. There is influence of work on family/social life. 10 % 12 % 27 % 28 % 23 % 20. Workspace is adequate. 12 % 12 % 27 % 33 % 16 % 21. There is chance of advancement. 8 % 9 % 30 % 33 % 20 % 22. 23. There is good communication with the manager. 5 % 11 % 37 % 25 % 22 % 24. There are opportunities for learning new skills in the organization. 9 % 13 % 28 % 30 % 20 % Izzivi prihodnosti / Challenges of the Future, Članek / Article Avgust / August 2022, leto / year 7, številka / number 3, str. / pp. 164–181. 173 In Table 1, the examinees' answers to all 30 stated claims can be seen, delivered in percentages. As previously stated, the choice of examinees was not formed according to a certain criterion, rather the research was done based on the principle of random source and encompassed employees from different sectors, and all skills profiles. The stated hypothesis is: H – Organizational manner affects the success of a healthcare institution business. “The manner of organizing affect the success of business of a healthcare institution” is connected to almost all the answers in this questionnaire, but several specific claims can be filtered out or chosen which are more or less connected to this hypothesis, so the analysis will take into account research answers from the claims 7, 11, 12, 16, 17, 28 and 29. Concerning claim 7, most examinees (38 %) answered that they were not sure that there is feedback concerning work performance. Concerning claim 11, most examinees (44 %) answered that they were not sure that employees appreciate the participation of the manager in the monitoring of jobs done by workers. Concerning claim 12, most examinees (32 %) answered that they mostly agreed with the claim that there are consultations connected to the changes at work. Concerning claim 16, most examinees (33 %) answered that they were not sure about the claim the attitudes of higher management are felt in work. Concerning claim 17, most examinees (39 %) answered that they mostly agreed with the claim that in the organization there are clear lines of reporting connected to the work. Concerning claim 28, most examinees (54 %) answered that they completely agreed with the claim that when the job needs to be done, teamwork is more important than hierarchy. Concerning claim 29, most examinees (42 %) answered that they were not sure that chiefs and managers do what they preach. In the organization there are clearly defined roles and responsibilities, the biggest number of examinees answered that they were not sure, that is 38 % of examinees, while 31 % of examinees mostly agreed with the claim, and 22 % of them completely agreed with it. In totality, 53 % of examinees agrees with the stated claim. 25. There is flexibility of work hours. 18 % 8 % 24 % 32 % 18 % 26. There are possibilities for using one's own skills on the job. 5 % 6 % 27 % 37 % 25 % 27. The organization recognizes my contribution to the work. 11 % 7 % 34 % 30 % 18 % 28. There are clearly defined goals, values, and procedures of the organization. 5 % 7 % 29 % 28 % 31 % 29. When the job needs to be done, teamwork is more important than hierarchy. 3 % 7 % 15 % 21 % 54 % 30. Chiefs and managers do what they preach. 9 % 9 % 42 % 27 % 13 % 31. All employees have a deep understanding for needs and wishes of the patients. 3 % 4 % 31 % 28 % 24 % Izzivi prihodnosti / Challenges of the Future, Članek / Article Avgust / August 2022, leto / year 7, številka / number 3, str. / pp. 164–181. 174 Work pace is adequate in the organization, 28 % examinees answered that they were not sure, 32 % of examinees answered that they mostly agreed, and 17 % of examinees answered that they agreed completely with the stated claim. Therefore, it can be concluded that most examinees agree with the given claim, in totality of 49 % considering the answers of the examinees that mostly agree or agree completely with the given claim. When it comes to the All employees have a deep understanding for needs and wishes of the patients, the answers given show that 7 % of examinees did not agree with the claim, 31 % of examinees were not sure, while the greatest number of examinees with the percentage of 38 % mostly agreed with the claim, and 24 % of examinees completely agreed with the claim. The conclusion is that 62 % of examinees gave a positive answer to the given claim. Concerning the The work environment is motivating workwise, 33 % of examinees mostly agreed, 21 % did not agree at all, while 25 % of examinees mostly did not agree, which represents the totality of 43 % of examinees who answered negatively about the given claim. Considering the In the organization there is management support, most examinees, that is 30 % said that they were not sure, 33 % of examinees answered negatively, while 36 % of examinees answered positively in relation to the stated claim. When we analyse the most specific, or rather the most representative chosen questions connected to the stated hypothesis, with the greatest percentage of examinees’ answers, 6 claims stand out, and these are claims 3, 5, 7, 11, 16 and 29, where the examinees gave answers that they were not sure, and which were related to work performance and manager role in the work. When it comes to the answer where the examinees mostly agreed with the stated claim, the greatest number of examinees answered the claims 2, 6, 12, 17 and 30, which have to do with work environment, attitude towards patients, work pace, consultations and reporting concerning work. Finally, the answer where the examinees completely agree, concerning claim 28, the greatest number of examinees answered positively and certified that teamwork is more important than hierarchy. The claims in which the greatest percentage of examinees answered that they agreed completely are claims 10, 13, 14 and 28, which have to do with interpersonal relations, or rather attitudes towards colleagues, teamwork, variety of tasks, and expertise in the work they do. The biggest percentage of examinees who answered that they did not agree with the claim at all refers to claims 1, 8 and 24, which refer to rooms for break, acceptable amount of work and work hours flexibility. Izzivi prihodnosti / Challenges of the Future, Članek / Article Avgust / August 2022, leto / year 7, številka / number 3, str. / pp. 164–181. 175 Based on the answers, it can be concluded that in the organization there is no such organizational structure or organizational culture defined which advocates the existence of feedback and hence a two-way communication, which is very important for efficient work of employees and influences a great deal the success of organization’s business. The existence of feedback affects work considerably, of those who are subordinate and of those who are superordinate as well. While subordinate employees can get the information about how they can improve their work performance, and therefore the performance of the whole organization, they can obtain information about the optimal way of doing work because it is precisely the employees working on jobs that get instructions that can speak best about the manner of doing their tasks. Except for the fact that most examinees stated that they mostly agreed with the claim that there are lines of reporting concerning work, the examinees were not sure that the attitudes of higher management are felt in work, which caused that the examinees were also not sure that chiefs and managers do as they preach, which reflects directly in the motivation of the employees. The existence of lines of reporting is also connected to the (non)existence of feedback in the organization. It is very good for the success of organization’s business the fact that the examinees mostly agreed with the claim that there are clear lines of reporting concerning work. It is bad if connected with the examinees’ answers that they are not sure about existence of feedback about work performance, and if there are no lines of reporting that go from lower to higher levels of hierarchy but only from higher to lower levels of hierarchy. It can be concluded that although the examinees were not sure that attitudes of the management are felt in work and that chiefs and managers perform what they preach, they do however think that teamwork is more important than hierarchy, which leads to the conclusion that there is an organizational culture that creates and cultivates relations between employees, although it might not be achieved through direct influence of higher management. It can be concluded that almost half of the examinees think that there are clearly defined roles and responsibilities in the organization, which directly affects the success of organization’s business. The existence of clearly defined roles and responsibilities creates such an organizational climate in which every employee has their clearly defined work tasks, which allows for the responsibility for the unfinished, as well as the finished task, not to be placed on other employees, but on the employee who was given the tasks, which further affects the motivation of the employees. If the employee doesn’t do/does their task, both sanctions and rewards are given only to them for the (un)finished work. Almost half of the examinees mostly or completely agree with the claim that work pace is adequate, which confirms that there are clearly defined roles and responsibilities in the organization and that the employees manage to finish their tasks within the timeframes they were given. That is also an important factor that affects the success of organizing, and of organization’s business, and it is reflected in the greater motivation of the employees. There is no “overflow” of responsibility for (un)finished tasks from one employee to another, and there are no rewards for (un)finished tasks. A large part of examinees (62 %) stated that they have deep understanding for needs and wishes of the patients, which is confirmed by the conclusions of the previous hypotheses Izzivi prihodnosti / Challenges of the Future, Članek / Article Avgust / August 2022, leto / year 7, številka / number 3, str. / pp. 164–181. 176 which say that the employees are motivated for performing their tasks. As it can be concluded from the answers that the employees are indeed motivated for doing work, a question arises about which factors affect the motivations of employees and the answer is that one of those factors is not work environment. 4 Conclusion The most important and basic task, in the very centre of organizing a healthcare institution is providing service, or rather healing patients. The healthcare system alone according to its organizational structure, its professional, legal, and financial position, requires proper reforms and changes, to preserve its functioning in meeting the needs of the patients and preserving the security of one of the basic human needs for adequate medical help. In Karimi (2015, p. 323), Australian employees using the conventional second order model and a bifactor model of WOAQ. In their research, they used two scales. The scale is relatively short, with 28 items. The WOAQ second-order model included a general measure of WOAQ at a higher order and five subfactors at the first order, each representing different dimensions of work organization risk assessment. To improve work, or rather, to improve efficiency and effectiveness in a healthcare organization, it is necessary to choose and apply scientifically and practically proven methods. Due to everything stated above, it is believed that today it is of vital importance that such a complex system should be governed, organized, directed and lead by a manager, with their team, for the organization to be more effective and efficient, which is a continuous and dynamic process that constantly grows, develops, and improves itself. The five subfactors are »quality of relationships with management«, »reward and recognition«, »workload issues«, »quality of relationships with colleagues« and »quality of physical environment«. The most important difference was detected when the conventional second-order model failed to recognize the low and differentially directed loading of the “quality of relationship with management”. In their research, the subfactor “reward and recognition” was identified as implausible by both models. These results have great practical implications. It shows that in the context of community nursing, although the general measure of WOAQ is a valid and reliable measure of the organizational risk assessment, the most important plausible subscales are »quality of physical environment«, “quality of relationship with the colleagues” and “the workload issues”. Based on the findings, the two subscales of “the quality of relationship with management” and “reward and recognition” are not that critical in such contexts. However, close evaluation of the reported work setting indicates that these findings should not be a surprise. These findings can perhaps be explained by the nature of the community nursing work environment because, although the nurses belong to a larger organization, they work in different, small branches with their own immediate managers/supervisors. Also, Karimi (2015, p. 325) said that the »reward and recognition« factor is strongly tied to the management relationship, and only items representing a variety of tasks, an opportunity for learning, and using the new skills appeared as important indicators of this subscale. Ultimately, this would assist management in identifying problem areas, which Izzivi prihodnosti / Challenges of the Future, Članek / Article Avgust / August 2022, leto / year 7, številka / number 3, str. / pp. 164–181. 177 may cause harm to their employees and the organization and allow proper action to be accomplished to prevent future occurrences of similar events. One more very interesting study is by Karimi (2020, p. 224). The current study has taken a novel approach to assess the validity of a psychosocial hazard assessment tool (WOAQ) for use in healthcare organizations and specifically for community nurses and paramedics. The results support the validity of WOAQ for use in community nurses and paramedics and that the tool can be used to support risk management approaches to identify and control relevant workplace hazards. They said that the higher score for the item »relationship with colleagues« suggests that for paramedics these relationships may be problematic and reflect the close nature of their work with another individual during their working shifts. According et al.’s (2014, p. 1363), it also supports the unique nature of occupational groups and the need for identification of local issues to inform the development of accurately targeted workplace risk management strategies. Community nurses reported more problems with workload compared with paramedics. The items captured for the workload issue construct consisted of pace of work, workload, and the impact of work on family and family on work. According to Hegg- Deloye et al. (2014, p. 244), the differences in demographic characteristics of both organizations may provide some insights into this finding. In the current study, a greater proportion of paramedics reported working part time in comparison with the community nurses. Thus, the ability for the paramedics to manage their home life may negate some of the other issues faced by workload. Schluter et al.’s (2011, p. 31), the sex breakdown of the sample may provide additional insights, as the predominantly female nurse respondents, who worked full time, may be juggling a range of care responsibilities in combination with their work which is in line with previous findings on this population. In accordance with the given results, it can be concluded that the organization's employees are motivated for performing their tasks, which is confirmed by the examinees' answers that teamwork is more important than hierarchy, as well as the answers that they have good relations with their colleagues, that their tasks are varied, and that they are prepared for performing their tasks based on their skills. The organization should work on improving the relationships between different hierarchical levels, so the employees can feel that their role in the organization is really appreciated by higher management and organizational culture should be cultivated because it creates a quality two-way communication in an organization, which increases the employees' motivation a great deal. As motivation is crucial for the success of every organization because human capital is the core of every organization, the organization needs to dedicate some work to workspace, rooms for break, as well as to considering more flexible work hours. Those are precisely the dimensions that can, according to the examinees' answers, increase employees' motivation and hence their results, and finally improve the overall performance of the organization. When it comes to limits of the research, it has to be noted that 120 examinees participated in the research and one of the suggestions for future research studies is for the sample size to be Izzivi prihodnosti / Challenges of the Future, Članek / Article Avgust / August 2022, leto / year 7, številka / number 3, str. / pp. 164–181. 178 larger and for the research itself to be repeated in other healthcare institutions in the Republic of Serbia. 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Member of the Medical Chamber of Serbia, with a valid license for independent work and Member of the Croatian Medical Chamber with valid PERMIT (license) for independent work. Member of the Presidency of the Association of Doctors of Vojvodina- Serbian Medical Association for a four-year term as of 2020. Author and co-author of several published works in domestic and foreign journals in the field of medicine he practices. *** Slobodan Mirosavljev is general and trauma surgeon. Medical manager. After many years of national and international work as trauma surgeon Slobodan found new passion in becoming a lecturer about surgical trauma approach as well as passionate organizer of numerous surgical ERTC courses. Last 5 years continued his professional work as a senior ICRC surgeon in Geneva and later as a surgeon and medical manager in international SOS and ICARUS. *** Vesna Turkulov was born in Novi Sad. She is a full professor at the University of Novi Sad, Faculty of Medicine. Hew narrower area of interest in infections of the central nervous system and HIV infection. She was the head of the department, then the head of the department and from 2012-2021. Years she was the manager of the Clinic for Infectious Diseases of the Clinical Center Vojvodina in Novi Sad. From 2015-2016., she was an assistant director Clinical center of Vojvodina for health activity. Winner of a large number of recognitions, plaques, awards for meritorious work. She is the author of the one monograph, and several textbooks and practicums and of over 250 scientific research papers published in national and international journals and conferences. Also, she participated in a number of national and international projects as a member and coordinator. Speaks English. *** Jovan Jolić was born in Kikinda, Serbia. Graduated in 2016 from “Dušan Vasiljev” gymnasium in Kikinda, majoring in informatics. Enrolled in the Faculty of the University “UNION Nikola Tesla – Faculty of Management” in Sremski Karlovci in 2018, for the bachelor’s degree in engineering management. Graduated in 2022. *** Slavica Mitrović Veljković was born in Pljevlja. She is a full professor at the University of Novi Sad, Faculty of Technical Sciences, Department of Industrial Engineering and Management and teaches the following courses: Principles of engineering management, Managerial decision making, Decision making and Change Management, Entrepreneurship and Managerial skills. She is the author of the book Principles of modern management and of over 100 scientific research papers published in national and international journals and conferences. Also, she participated in a number of national and international projects. Speaks English and Italian. *** Jelena Raut was born in Novi Sad. She completed her undergraduate, master’s and doctoral academic studies at the Faculty of Technical Sciences at the University of Novi Sad, Department of Industrial Engineering and Management. She is the author or numerous scientific research papers, with a narrower sphere of interest in entrepreneurial ecosystems and digital entrepreneurial systems. *** Izzivi prihodnosti / Challenges of the Future, Članek / Article Avgust / August 2022, leto / year 7, številka / number 3, str. / pp. 164–181. 181 Povzetek: Stopnje dojemanja organizacijske uspešnosti zaposlenih v zdravstveni organizaciji Raziskovalno vprašanje (RQ): Predmet raziskave je opredelitev in analiza procesa organizacije v zdravstveni organizaciji ter percepcija zaposlenih glede uspešnosti organizacije. Namen: Cilj raziskave je ugotoviti način organiziranja, to je fazo v procesu oblikovanja organizacijske strukture v zdravstveni organizaciji, ter ugotoviti stopnjo zaznavanja organizacijske uspešnosti zaposlenih v tej organizaciji. Metoda: Raziskava je bila izvedena s pomočjo standardiziranega vprašalnika (Griffithsetall, 2006), ki vsebuje 8 vprašanj, povezanih z osnovnimi demografskimi podatki zaposlenih in 30 vprašanj, povezanih s predmetom raziskave. Rezultati: Dokazovanje raziskovalnih vprašanj in hipotez v raziskavi vodi do ugotovitve, da jasno opredeljene vloge in odgovornosti, obstoj ustreznega tempa dela, poglobljeno razumevanje želja in potreb pacientov s strani zaposlenih ter motivacija zaposlenih za delo vplivajo na uspešnost dela. Zdravstvena organizacija, torej način organiziranosti, pa vpliva na njeno poslovno uspešnost, medtem ko delovno okolje ni dejavnik, ki vplival na uspešnost zdravstvene organizacije. Organizacija: Zdravstveni sistem po svoji organizacijski strukturi, strokovnem, pravnem in finančnem položaju potrebuje ustrezne reforme in spremembe, da bi ohranil svoje delovanje pri zadovoljevanju potreb pacientov in ohranitvi ene od osnovnih človekovih potreb, po pravici do ustreznega zdravljenja. Za izboljšanje dela v zdravstveni organizaciji se je treba lotiti in uporabljati znanstveno dokazane in v praksi preverjene metode. Nujno je, da kompleksen sistem, kot je zdravstvena organizacija, upravlja, organizira, usmerja in vodi vodja s svojo ekipo, da bi bila organizacija bolj učinkovita in uspešna. Gre za kontinuiran proces, ki je dinamičen in nenehno napreduje, se razvija in izboljšuje. Družba: Glede na vpliv na družbo, skozi zgoraj opredeljene ukrepe, ta raziskava predlaga način, kako ohraniti delovanje zdravstvene organizacije, zadovoljiti želje in potrebe pacientov ter ohraniti eno od osnovnih človekovih potreb, to je pravico do ustreznega zdravljenja. Izvirnost: Predmet raziskave je preučevanje stopenj percepcije zaposlenih glede uspešnosti organizacije, obstajajo razlike v percepciji splošnih demografskih značilnosti zaposlenih. Zato so opredeljene nadaljnje usmeritve glede na organizacijsko strukturo in kulturo zdravstvenega zavoda. Omejitve/prihodnje raziskave: Predlog za prihodnje raziskave se kaže v povečanju vzorca preiskovancev in ponavljanju raziskav v zdravstvenih organizacijah po državi. Ključne besede: zdravstvena organizacija, organizacijska struktura, načrtovanje organizacijske strukture, percepcija uspešnosti organizacije, način organiziranja. Copyright (c) Siniša JOLIĆ, Slobodan MIROSAVLJEV, Vesna TURKULOV, Jovan JOLIĆ, Slavica MITROVIĆ VELJKOVIĆ, Jelena RAUT Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.