The researcher is a healthcare professional employee of a Southern California private hospital (Asylum) providing psychiatric and chemical dependency in-patient and out-patient treatment to adolescents. Recently, a major operational change took place at the institution, viz. heretofore long-term residential care was replaced by short-term residential care followed by out-patient consultation. The change constituted a conjuncture, i.e. a critical state of affairs for the facility, inasmuch as management, healthcare professionals, and patients had to adapt to fundamentally different management and healthcare delivery modalities. The alleged cause of the conjuncture was the drastically reduced insurance coverage of treatment costs - a move the insurance companies claimed had become necessary in the face of steeply rising healthcare delivery costs.
As a member of Asylum's direct-delivery healthcare staff, the researcher's unsystematic and undocumented personal observations of the general behavior of the facility's employees led him to perceive apparently significant changes in attitudes among administrative middle managers and direct-delivery healthcare providers since the conjuncture. It appeared to the researcher that administrative middle-managers' newly expressed major concern was operational cost-effectiveness - even at the cost of lowered quality in therapeutic standards. They expressed understanding and acquiescence of the new treatment strategy, as long as it ensured profitability for the hospital.
On the other hand, healthcare professionals by and large clearly deplored what they considered to be a lowering of therapeutic standards and efficacy; they sought self-justifying definition of their professional status and functional effectiveness under the conjuncture; and they held negative and often prejudiced views of the hospital's top management, of insurance companies, and of their own State and professional organiza...