Health Care Researcher

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 ensur

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ethods, in that it was conducted in cooperation with a working healthcare facility for its practical benefit as well as for that of similar institutions. The project was subtitled A Micro-Analysis in Social Change because conceptually and methodologically the researcher conducted the study within the perspective of symbolic interactionist and dramaturgical theories of sociology - in particular that of Erving Goffman. The choice of operational concepts and of methodological orientation was dictated by the advantage of the researcher's position as an Asylum employee, position which had given him and would further give him daily opportunities to observe group and individual interactions at the micro level. As a participant-observer in the dynamic social situation, he hewed closely to the strategic approach of reality reconstructionists (including symbolic interactionists) who describe social dynamics as insiders rather than, as do positivists, as outsiders. In order to provide a limited check on the very subjective nature of behavior observation, the researcher resorted to an opinion poll instrumentalized through written questionnaires and through structured and unstructured individual interviews. Basically, then, the project wa

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