On hierarchy, I take the view that a management hierarchy using fitness functions combined with an autonomous cell based structure using multiple cultures i.e. the PST model is a more effective way but it requires doctrine & maps to be in place before it can even be contemplated.
However, don't start fiddling with the deckchairs on a sinking Titanic until you've fixed the core problem ... look to doctrine to help. 
Re-orgs won't help fix underlying weaknesses in doctrine ... I tend to avoid the unecessary pain of a re-org until I've fixed those issues first.
