Refer to the Scenario Below to Answer the Following Questions

Refer to the scenario below to answer the following questions.
Metro General Hospital (Scenario)
Joyce is the chief administrator in charge of a department at Metro General Hospital. When she worked as a registered nurse at a smaller community hospital, Joyce enjoyed the flexible structure, minimal rules, and team approach to decision making by nurses, administrators, and doctors. However, the situation at Metro is different. Metro has a tall, rigid structure with many rules and procedures designed to standardize jobs and guide employee behaviour. One such rule requires that all decisions in Joyce's department must be signed off by her alone) As a result, Joyce seems to spend most of her time filling out forms and signing documents. She also feels that the numerous levels of hierarchy are unnecessary and place barriers between herself and her staff. Joyce is not exactly sure why things have to be so "organized" and is planning to talk to her boss about making some changes to increase flexibility and reduce the number of rules and procedures.
-The requirement that Joyce sign off on all decisions in her department specifically relates to which of the following elements of structure?

A) centralization
B) span of control
C) departmentalization
D) unity of command
E) formalization