Although most concepts of organizational
design focus on formal structures, our expanded
concept of design includes the design of policies,
procedures, and practices that turn structure into
action. The same formal structure can produce
very different behaviors if different processes are
used. For example, surgical teams learning the
same minimally invasive techniques produced
very different results depending on their leadership
and communication practices.17 Thus, the
effectiveness and sustainability of the formal
structures and processes are linked to the
informal organization of people, politics, and
culture. Organization theorists are focused
increasingly on designing aspects of the informal
organization including the learning organization,
18 informal networks,19 improvisation,20 and
safety culture.