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An organizational structure identifies the roles and responsibilities of those in leadership positions that will impact the goal of the organization and (Renani, Ghaderi & Mahmoudi, 2017). It also indicates how information is shared through the various levels of leadership (Marquis & Huston, 2017). It identifies the hierarchical leadership structure of an organization for accountability ( Renani et al., 2017).
SLMC is a healthcare organization that has cared for a number of its neighboring communities in the Chamberlain County of South Carolina for the last 50 years. The organization consists of 500 physicians and 450 nurses and as such needs an organized way to function where roles are defined so the goals of the organization can be met. The purpose of the organization is to improve quality care and safety and to make improvements in healthcare and to provide care of the surrounding communities.
As the nurse administrator, the organizational structure that would be best for St. Louis Medical Center (SLMC) would be the shared governance. Shared Governance in healthcare is an essential component of providing quality and safe care to patients (Marquis & Huston, 2017). Based on the structure, the decision-making process is in collaboration with board members, physicians, the leadership team, and nurses (Marquis & Huston, 2017). The structure is made of several committees tasked to lead and make decisions which will affect the care of the community. Shared governance also supports empowerment through nurse autonomy and decision making (Marquis & Huston, 2017).
The organizational theory best for this type of structure would be the contingency theory. The contingency theory allows the organization to respond to its priorities based on the needs of the organizations as well as its community  (Birken, Bunger, Powell, Turner, Clary, Klaman, Weiner, 2017). The reason this type of theory would be ideal is that the structure would facilitate the development of a committee to respond to its community’s challenges. For example, addressing issues related to the ten percent increase in heart failure admissions noted. This organizational theory will positively impact the institutional goals based on the changes that can be made that will address issues inside and outside the organization and its mission and vision. 
Jean Latouche
References
Birken, S. A., Bunger, A. C., Powell, B. J., Turner, K., Clary, A. S., Klaman, S. L., … Weiner, B. J. (2017). Organizational theory for dissemination and implementation research. Implementation science : IS, 12(1), 62. doi:10.1186/s13012-017-0592-x
Marquis, B. L. & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application. (9th ed.). China: Wolters Kluwer Health.
Renani, G. A., Ghaderi, B., & Mahmoudi, O. (2017). The Impact of Organizational Structure on the Effectiveness of Communication from the Perspective of Employees in the Department of Education. International Journal of Management, Accounting & Economics, 4(10), 989–1001.