Politics, administration, and confliict in neighborhood health centers.

Abstract

The paper begins with a brief introduction explaining neighborhood health centers (NHCs), their ideology of “comprehensive health services,” and the origin of government sponsorship of this organizational form for the delivery of health care. In the generic account and in a subsequent discussion of a particular NHC (given the fictional name Peoples' Health Centers or PHC), particular attention is given to political aspects. PHC was established as a private, consumer-oriented, not-for-profit community corporation receiving grant funds from the Office of Economic Opportunity (OEO). Although the grantee was legally responsible for the funds, OEO required that a local university be awarded a large subcontract to provide health professional personnel and technological back-up. Severe conflict surrounded the relationship of these two local health institutions. In an analysis section offering an “explanation sketch” of an instance of political conflict, the paper develops a distinction between “political” and “administrative” perspectives that explains political conflict as a function of differences in the ways participants conceive of their organizations and activities. This distinction is then related to Etzioni's theoretical distinction between survival and goal-attainment models of organizational analysis. The paper concludes by making explicit four lessons that are intended to reassert the policy-orientation of the initial remarks.