Organizational deviance: Some evidence from local health planning

Abstract

In this paper I explore relationships between health systems agencies (HSAs) designated under Public Law 93–641 and their constituencies. I examine how local health providers, primarily hospitals, relate to the activities of the three HSA functions: plan development; health systems development; and project review. The emerging literature on organizational deviance provides a conceptual framework in which to locate noncompliance of health care providers with HSA goals, objectives, and project review standards. Elements of labeling theory are used to stimulate discussion of the reactions health care providers have to HSA activities. I find that while HSAs function to coordinate health care communitywide, that is, they take a systematic approach, each health care provider takes a much less cosmopolitan view and adopts an idiosyncratic needs approach. The negative consequences this has for the various constituencies are reviewed.