Administrative
Incongruence and Authority Conflict
In
Four Abortion Clinics
WARREN M. HERN
MARLENE R.
ANNAGAIL OAKS
WHEN THE REFORM
<=
/span>One
of the results was the emergency of the free-standing abortion clinic devot=
ed
entirely to the performance of this procedure. As laws in
<= /span>These clinics caught the attention of the public and medical observers, but they particularly appealed to the patients.&nbs= p; They offered a minimum of bureaucratic process and delay, relative privacy since no hospital admission was required, and lower cost. In addition, many individuals saw = in the clinics an opportunity for social service and advancement of the “cause.” This inc= luded physicians, lay counselors, social workers, nurses, ministers, and administrators. Some clinics offered the prospect of high pay, especially for doctors, many of whom felt that the activity endangered their professional status or standing with the= ir colleagues.
&nb= sp; The free-standing abortion clinic became a unique health care delivery system in providing a highly specialized service for patients whom some define as entirely healthy and others define as having unusual needs. These needs are perceived as inclu= ding information, education, birth control assistance, and most importantly, emotional support. Differing = views about the medical risks of abortion and the emotional status of the prospective abortion patient resulted in varying styles of operation and organization.<= span style=3D'mso-spacerun:yes'> A question which constantly arose = was that of which pattern would yield the best result for both the patients and= the clinic staffs.
<= /span>The early clinics shared many characteristics.= There was intense involvement on the part of the actors. There was confusion, constant cris= is, drama, and frequently, administrative chaos. The activities took place in a con= text of public controversy and private anguish.= Abortion clinics tended to attract individuals with high social commitment and medical personnel with both poor and exceptionally high technical abilities.
&nb= sp; This ménage was colored by conflicts between the desire to offer services= at the lowest possible price, the emotional and financial costs of providing g= ood service on a continuing basis, the willingness of patients to pay large sums for any kind of service, and the intent of some to exploit both the patients and the socially committed in order to obtain large profits.
<= /span>Many abortion clinics have experienced important changes in structure and operat= ing methods along with almost total staff turnovers. Part of this has been the result o= f the fact that the emotional intensity characteristic in the early days was difficult to sustain. People = felt “burnt out” and had to quit or move on. Another source of uncertainty has = been widely fluctuating patient loads resulting from increasing availability of services throughout the nation.
<= /span>The senior author (WH) became interested in the abortion clinic as a social organization after being asked to perform a management study of a model nonprofit clinic in an Atlantic coast city. In this clinic (Clinic A), he note= d some trends in bureaucratization and authority conflict which appeared to produce discomfort for the staff of the clinic if not compromises in the quality of medical care.
<= /span>Subsequently, WH was asked to help start a small nonprofit abortion clinic (Clinic B) in a Western college town, which he did, serving as Medical Director and perform= ing almost all the abortions for the first 14 months of the clinic’s existence.
<= /span>At the urging of WH, author AO was engaged as Head Nurse at the founding of Cl= inic B because of her two years’ experience as a staff nurse at a large abortion clinic (Clinic D) in another East coast city. She remained in this capacity as H= ead Nurse until shortly before WH left Clinic B.
<= /span>MG was present when Clinic C was opened in a northeast industrial city and was subsequently Head Counselor there for a period of one year.
Organizational Theory
&n= bsp; In examining the abortion clinic as a social organization, it is useful to stu= dy theories of organizational structure, power relationships, and administrati= ve styles. Some of the most help= ful concepts have been developed by Etzioni (1961), by Goldhammer and Shils (19= 39), and by Price (1968).
<= /span>Etzioni describes three types of compliance structures: normative, utilitarian, and coercive. An example of a nor= mative structure would be a political or religious organization devoted to a certa= in ideology or other normative values. A utilitarian structure would be characterized by a business corpora= tion or factory. A prison would be= the clearest example of a coercive structure.
<= /span>Each of these organizations tends to utilize its most appropriate, or congruent source of control over its members: normative values, economic remuneration= , or coercion.
<= /span>One theory expressed by Etzioni is that organizations tend to have a compliance structure which is congruent; i.e. a normative organization tends to utilize normative values or expressive communication, such as indoctrination or approval, for control of its members rather than, for example, coercion or economic rewards. Etzioni hol= ds that organizations which have congruent compliance structures resist change toward incongruent compliance structures, and compliance structures which a= re incongruent tend to become congruent (1961:14).
<= /span>Leadership styles may generally be defined as either charismatic or instrumental in all but the coercive structure, with which we are not concerned here. While both styles may be found in = both normative and utilitarian organizations, charismatic leadership and decisio= n making tends to be more characteristic of normative organizations, whereas calcula= tive or instrumental decision making is more typical of utilitarian organization= s.
<= /span>One possible source of conflict in abortion clinics becomes apparent immediately upon examining Etzioni’s typology: the abortion clinic is, or has bee= n, both a force of social change (normative values) and a provider of certain technical and/or professional services (instrumental action).
<= /span>Depending on the premises or philosophy of the operators, the abortion clinic is more like a professional organization, which Etzioni characterizes as not a “remunerative industry” but is the least normative of normative organizations. Professional organizations tend not to specialize in the creation or expression of cultu= re, as do most normative organizations, but are concerned with the application = of culture. They are defined by = their goals, which are professional goals such as teaching, research, and therapy. They are also define= d by the rank at which professionals are employed (1961:51).
<= /span>In the professional organization, the top ranks are primarily formed by lay ad= ministrators or nonpracticing professionals whose main concerns are means-decisions and instrumental activities such as maintenance of the physical plant, operating budget, and supplies. Profess= ionals in the middle ranks make decisions about ends and their activities relate directly to the organizational goals of, for example, diagnosis and treatme= nt or research (1961:219).
<= /span>Charisma, which is a major source of legitimation for an organization or its activiti= es, tends in a professional organization to be concentrated among the professio= nals themselves. Their two sources= of ascribed charisma include their status as accredited professionals and their organizational positions. Etz= ioni points out that the development of charismatic leadership in the top administrative positions of a professional organization is dysfunctional because it tends to interfere with professional decisions and professional = goal related activities (1961:220).
<= /span>No organization is a pure stereotype of any of these constructs, but is a composite which may have a dominant characteristic. Furthermore, Etzioni offers the dy= namic perspective that “Many organizations are more charismatic in the first period of their existence than at later times” (1961;228).
Case Studies
<= /span>The following case studies of four abortion clinics illustrate some of the principles of administrative incongruence.= In the first three (Clinics A, B, and C), authority conflict was end= emic in the organizational structure. By contrast, the fourth clinic (Clinic D) contained no authority conflict and superficially, little administrative incongruence. The information was obtained in all cases through the participant observation technique, although none of the authors participated in the described activities in order to report them la= ter, with the exception of the management study of Clinic A. Even here, publication of any of t= he observations or conclusions was not anticipated.
CLINIC A. Clinic A was opened in 1971 with t= he purpose of being a model nonprofit abortion clinic. The clinic’s objectives were= not only to provide patient care but to provide an example of how a first rate outpatient abortion facility should operate.
<= /span>The clinic was set up with a full-time medical director who was a highly qualif= ied and experienced Ob-Gyn specialist. There was an intensive training program for lay abortion counselors conducted by a leading local psychiatrist.= The counseling program emphasized one-to-one counseling of patients = and group counseling for relatives and friends of relatives.
<= /span>The entire staff was conscious of the clinic’s role as a leader in provid= ing abortion services and as a model for other clinics. Morale was initially high. The counselors, in particular, were strongly committed to the clinic’s activities. They were young, idealistic, and h= ighly dedicated.
<= /span>At the time of the management study, Clinic A had been open for 18 months and = had provided abortions for some 15,000 patients. Between 50 and 60 abortions were d= one per day. There was a staff of nearly 100. The study was don= e over a three-week period and included open ended interviews with 59 staff member= s ranging from the autoclave technician to the executive director. The author also observed and perfo= rmed a number of abortions and vasectomies as part of the participant-observer strategy. Many informal conversations and observations took place in the staff lounges over coffee = and with doctors in between procedures.
<= /span>The management study showed widespread severe dissatisfaction among the staff, especially the counselors. The principal complaints centered around the lack of communication within the organization and the autocratic methods of the executive director. The first rank professional superv= isors, such as the clinic director, nursing director, and director of counseling, often were not informed, much less consulted, regarding major policy or administrative decisions made by the executive director.
<=
/span>For
example, decisions about scheduling, the number of patients to be accepted,=
and
hiring of new personnel were frequently not communicated to the supervisors
except by accident after the policy had taken effect. The supervisors then had the respo=
nsibility
for carrying out the policy without having the opportunity to discuss its
impact with the executive director.
The result was confusion, tension, delays, overwork, and anxiety.
<= /span>The executive director herself was widely admired as an intelligent, committed,= and talented leader with many positive qualities. She was perceived as a dynamic per= son who really cared what happened, but she was also perceived as authoritarian, autocratic, paranoid, vindictive, and unable to tolerate questions or complaints.
<= /span>The executive director felt under great pressure by the overall director of Cli= nic A to perform and produce revenues by having as many abortions done in the clinic as possible. The funds= were being used to finance similar clinics in other cities and expand Clinic A’s program to include sex counseling, vasectomy, and pregnancy testi= ng services.
<=
/span>Many
staff members, especially counselors, felt that these stresses and expansio=
ns
were occurring at the expense of good medical care for the abortion
patients. “The machine =
is
turning on the people who created it.” “It’s the nitty-gritty
people who keep the place functioning.” “The longer the clinic stays=
open
the worser (sic) the situation gets.” “[Clinic A] is on the verge =
of
becoming an abortion mill and slighting the patients – especially if
it’s going to be bankrolling other operations.” “Are we moving toward being =
an
abortion mill and a very inefficiently run abortion mill at that?”
<= /span>The conflict between the professional supervisors and the executive director intensified when the executive director was absent. She gave telephone commands occasi= onally through her secretary, who essentially was in charge of the clinic. The professionals had no autonomy = to make decisions and one was in command in her absence. When she was present, disagreement= s and conflicts abounded. Two plain= tive questions reflected this: “Who do you go to?” “Who can you tell the truth to?”
CLINIC B. Clinic B was formed in mid-1973 in response to efforts by several interested women and two male physicians, neither of whom were gynecologists. A male sociology graduate student who had worked with a local drug a= buse program was also involved in some unsuccessful early attempts to persuade l= ocal gynecologists to help start such a nonprofit clinic.
<=
/span>Because
of previous administrative and clinic experience with abortion, WH was invi=
ted
to help for the clinic and to be the permanent physician. A program plan was proposed and ad=
opted
which made the sociology student the executive director and WH the medical
director. A board of director=
s was
formed. A loan was obtained a=
nd
plans went forward to rent space, lease equipment, hire a nurse, and train
counselors. The model for the
clinic was Clinic A. A head
counselor was hired by one of the original physicians, who was a board memb=
er,
without the knowledge or consent of either the executive director or medical
director. The head counselor =
had
experience as a lay counselor at an abortion clinic in
<= /span>The clinic was launched in late 1973 amid statewide public controversy about its right to exist. The local Rig= ht to Life organization attacked the clinic, asking the city council and health department to close it. An at= tack within the county medical society was directed toward the clinic and the clinic’s medical director. The medical director obtained his local hospital privileges over the strenuous objections of some hospital staff members who opposed abortion or= who perceived the possibility of economic loss as the result of a low cost abor= tion service in the community. The State Board of Health called a hearing to consider licensing abortion clini= cs as the result of an appeal by a community group opposed to the clinic. The medical director testified at = the hearing and the matter was dropped.
<= /span>The atmosphere at the clinic was one of siege, tension, and exhilaration at the sheer establishment of the clinic. The medical director was seen by some members of the clinic staff as somewhat of a hero, albeit a reluctant one.
<=
/span>From
an administrative point of view, most of the policies and actions which the
medical director recommended at this time were adopted. The medical director’s effor=
ts to
create both the substance and appearance of a first class medical program w=
ere
accepted and were successful. The
clinic was visited by a delegation from the county medical society, for
example, composed of two gynecologists expressing open hostility to the cli=
nic. One of these had been instrumental=
in
having the clinic’s first lease cancelled. Their report to the medical society
stated that the clinic’s medical standards were “exemplary and
commendable...equal to the highest medical standards in the city...”<=
/p>
<=
/span>Within
eight months after the clinic opened, however, the medical director and head
nurse felt overwhelmed by the work load.&n=
bsp;
This consisted not only of care for 25-30 abortion patients per week
plus all screening and follow-up exams, but many routine chores including
cleaning and clerical work. T=
here
was a serious shortage of equipment.
The executive director protested his innocence of administrative
responsibilities, claiming to be a sociologist engaged in writing a book ab=
out
the clinic. The executive dir=
ector
perceived the medical director’s requests for additional equipment as=
unreasonable
and unobtainable because of the lack of money. He claimed that the medical direct=
or and
head nurse should work on their “relationship” as a way of solv=
ing
the problems. <=
/span>One
year after the opening of the clinic, the head nurse resigned. She felt that she was constantly c=
aught
in the middle between the medical director and the executive director, who
continued to view the complaints by the physician and nurse as the result of
their alleged interpersonal conflict rather than the result of any substant=
ial
need for administrative action.
Meanwhile, most of the original board of directors resigned, some ci=
ting
despair at the poor management of the clinic as their reason. <=
/span>Fearing
charges that he was sexist, the executive director decided to have a female
codirector and divide the job with her.&nb=
sp;
One of the counselors was chosen for this position. The efficiency of the decision mak=
ing
process was not enhanced by this step.&nbs=
p;
For example, the medical director requested permanent help to clean =
and
prepare instruments in the operating area, to do routine cleaning, and to s=
tock
supplies. After several
consultations between codirectors, the reply was that this would not be done
because there was no money. I=
t was
suggested that raising fees would provide the money. “We voted not to raise
fees.” The medical dire=
ctor
repeated an earlier request for locking steel file cabinets for medical
records, but a decision either way was not reached. <=
/span>The
conflict and tension grew to the breaking point after the resignation of AO=
as
head nurse. The medical direc=
tor
requested a meeting alone with the executive director and head counselor to
work out differences and to ease tensions.=
He stressed the need for the highest professional standards of medic=
al
care. The executive director
replied that he “hated professionalism,” and the head counselor
concurred. The executive dire=
ctor
expressed the view that the main purpose of the clinic was the personal gro=
wth
and maturity of the women who worked in the clinic, and that the patients w=
ere
secondary and incidental to this purpose.&=
nbsp;
The medical director said he perceived the goal of the clinic to be =
the
provision of safe abortion services for the patients. <=
/span>The
following day, the executive director violated the confidentiality of a
patient’s records by discussing a sensitive item with the patientR=
17;s
companion without her consent.
Shortly thereafter, the medical director asked the board to request =
the
executive director’s resignation. <=
/span>From
that point, board meetings as well as daily clinic activities were occasions
for hostile confrontation. Th=
e head
counselor, a strong individual who viewed the clinic as part of a larger
political movement, mustered the loyalty of the new board. The medical director was increasin=
gly
isolated in his views. His de=
mands
were perceived as irrational and impractical by most of the rest of the sta=
ff,
particularly the executive director.
His recommendation that the clinic have a single director with clear
authority and responsibility was rejected on the grounds that it gave one
person too much power. =
This
brought about a general perception that there should not be anybody over
anybody else and, for one thing, the authority of the doctor or doctors in =
the
clinic must be reduced. The b=
oard
voted to abolish the position of medical director, offering continued part-=
time
employment to the one whose position they had just abolished. He resigned at that point, citing =
the
need for medical accountability which the position of medical director
provided. CLINIC C. The owners of clinic C were not ea=
sily
characterized as driven by commitment to social change or social justice.
<= /span>The first administrator of Clinic C was a minister, locally known for his work = in abortion counseling and leadership in this area. The administrator was therefore a = highly visible and well-known individual with a commitment to social progress as h= is main concern. He concentrated= on establishing a strong counseling program for patients and relatives; also, = he provided important community liaison for the clinic because of his previous contacts.
<= /span>The medical director was chosen by the owners, who lived in another city and ra= rely visited the clink. The medical director, also highly regarded by his colleagues in the community, operated with relative autonomy from both the owners and the administrator. The staff physicians appointed by = the medical director were highly competent in general, albeit wholly insensitiv= e in some cases to the emotional needs of the patients. They operated more or less autonom= ously once hired since the medical director seldom appeared and almost never supervised them.
<= /span>The head nurse was hired by the medical director but from that point on functio= ned without supervision except to receive occasional large shipments of wholly inappropriate supplies obtained as “bargains” by the absentee owners. A large stockroom was= used for storing these useless items. The head nurse actually functioned as the medical director, managing physician’s schedules and arranging for treatment of complications as they arose. She ordered suppl= ies and hired nursing personnel as she saw fit without consultation with the administrator.
<=
/span>The
first administrator remained during the first eight months of the
clinic’s existence, then left to return to graduate school. After a time, he was replaced by a=
nother
minister who lived near the owners and commuted sporadically to the
clinic. The second administra=
tor
had a similar background to the first but in addition, he had also helped t=
he
owners start a similar clinic earlier.&nbs=
p;
His tenure was only four months since the commute became difficult.<=
/p>
<=
/span>Some
time afterward, a third administrator appeared on the scene, a young man wi=
th a
degree in public health administration.&nb=
sp;
He was hired as an administrator, he thought, because of his
professional qualifications in this field.=
He actually expected to administer the clinic. <=
/span>His
first task as an administrator, as he saw it, was to obtain information abo=
ut
what was happening. He sought
reports and figures from every department, designing flow charts and making
projections. The one set of
information which he could not obtain, however, was the amount of money com=
ing
into and going out of the clinic or how it got divided up in between. The bookkeeper knew, but she would=
n’t
tell him. She was under order=
s, in
fact, from the owners not to tell any of the administrators. He was just the first to ask. <=
/span>Any
administrator knows, of course, that in order to make intelligent decisions=
one
has to know how much money there is to do whatever is to be done. Power follows money, and money is =
the
bottom line in a profit making operation.&=
nbsp;
Whoever controls that information controls the organization. The owners controlled, and their p=
roxy
was the kindly, elderly bookkeeper who was no genius but had an absolutely =
firm
position because, in the words of one of the owners, <=
/span>Not
only did the administrator find it impossible to obtain the essential
information which he required for effective decisions, he constantly receiv=
ed
instructions, sometimes through the bookkeeper, about medical, nursing, or
administrative policies which he was to carry out. These included hiring certain doct=
ors on
no other grounds that that they were friends of friends of someone. <=
/span>The
administrator, a man of independent streak and professional pride, lasted
approximately two months in the face of the clinic’s total resistance=
to
being administered by someone whose responsibility was to do just that. <=
/span>The
effect on the staff was demoralizing, in one respect, in that constant
confusion prevailed in administrative matters. No one really was in charge
overall. Those with any super=
visory
authority, such as the head nurse, fended for themselves, making up policy =
as
they went along. It was a str=
ategy
of divide and conquer since no one had enough information to dominate
completely another fiefdom. <=
/span>In
other respects, the professionals, such as the head nurse and head counselo=
r,
took pride in their work and found it satisfying. They found it possible to work with
relatively little interference, isolating themselves partially from the
constant injunctions from the owners that the clinic must make money and fr=
om
the influence of concern for profits over professional considerations. CLINIC D. One of the busiest abortion
clinics in the Northeast was Clinic D.&nbs=
p;
The clinic’s average volume was about 100 patients per day.
”she reminds me of my mother.”
<= /span>There is no authority conflict in Clinic D. One person, Dr. Z, owns the clinic and runs it on a day-to-day basis. He is a good abortioni= st. That fact is recognized by everyone. He is absolutely in charge. That fact is also recognized by everyone.
<= /span>The administrative policies are clear, and the consequences of violating them a= re immediate. You get fired. There is no talk of idealism here,= of social change or making the patients comfortable. This is a business proposition.
<= /span>Everyone is on the same footing, from doctors to instrument washers. The nurses punch a time clock. Everyone calls it “the factory.” The one thing= that unites the staff in a superficial way is fear of the management.
<= /span>Dr. Z wants information and he gets it from his employees. He calls it “feedback.”= ; His employees call it “screw= your buddy.” There is = no job security, there is plenty of anxiety, and there is no loyalty beyond the paycheck. It is a gritty, wor= k-like-hell-and-let’s-get-out-of-here atmosphere.
<= /span>Medically, one thing distinguishes Clinic D from others previously described: the pati= ents are under general anesthesia during the abortion. The patients are group counseled a= nd doctor-patient contact is minimum if not nonexistent. When the patients wake up they are woozy, sick, and rather uncommunicative.&n= bsp; Their care during the recovery period is little more than custodial,= but it is efficient and competent.
<= /span>What does Dr. Z want? Money. What must he have in order to get it? Performance. Employees perform with precision e= xactly within the rules provided or they go elsewhere to work. Sometimes, however, they merely lie about their performance.
<= /span>The doctor is primarily a technician in Clinic D. The doctor is not expected to rela= te well to patients, explore their medical histories for diagnostic nuances, o= r be especially pleasant to anyone. What is expected from the doctor is a technically perfect abortion in each case. Too many complications = and you’re out.
<= /span>Some doctors don’t think this atmosphere squares with their roles as professionals, as independent decision makers. It doesn’t, of course, but i= f you criticize it or try to enlist others in your view, you will soon find a new atmosphere in which to work. = Others may share your attitude but don’t expect them to join you. They have their jobs to look after= .
Discussion
<= /span>At the time of its opening, Clinic A demonstrated many normative characteristi= cs owing to the high degree of social commitment and altruism of its founders = and staff. This was most evident = among the counselors. The clinic= 217;s original medical director was highly charismatic, being extremely popular a= mong the staff, and in addition his ascribed charisma resulting from professional expertise helped legitimize the clinic’s activities.
<= /span>In time, the clinic necessarily experienced the bureaucratization and routinization of many professional functions, as evidenced by the developme= nt of departments headed respectively by a physician, a nurse, and a social worker. The executive directo= r, however, continued to operate in a charismatic fashion which had been appropriate at the beginning. In order to function, the clinic had developed a rational-legal system of deci= sion making (Price 1968:55) which conflicted with her administrative style. She tried to operate a compliance = system incongruent with the structure which emerged out of necessity in providing a complex service.
<= /span>Clinic A provides a perfect example of Etzioni’s theory that the development= of charisma in the top administrative positions in a professional organization= is dysfunctional. Etzioni notes = that this development “...gives the administrator additional power, which = may be used to overemphasize values such as economy, efficiency, and instrument= al expansion, while direct service of the professional goals of the organizati= on is neglected...” (1961:220).
<= /span>Clinic B illustrates the same principle. Clinic B’s origins were even more charismatic and normative as= the consequence of the community atmosphere of hostility and controversy. The medical director was thrust in= to a highly charismatic position, willy-nilly, in addition to his ascribed charismatic properties as a professional.&= nbsp; The charisma of his office and function in the clinic was a powerful source of legitimation for the clinic in numerous ways, and the organizatio= nal goals which he perceived were achieved rather quickly at the beginning.
<= /span>As the controversy subsided, however, the medical director’s charisma diminished by comparison with its previously exaggerated level. It also diminished within the organization because, as it turned out, the executive director and head counselor held values which were highly antagonistic to the more general as= cribed charisma of professionals and doctors in particular. The executive director found himse= lf in a charismatic power position by virtue of the office he held and default of= the original board of directors, and the head counselor developed a charismatic power position by the same means.
<= /span>Both of these individuals not only deprecated the role of professionals but saw = the clinic as serving normative goals primarily rather than professional or instrumental goals. This disagreement within the top organizational structure helped create a serious incongruence in the compliance structure as the professionals, the medical director and head nurse, tried to bring about a rational-legal system consistent with service of the professional goals which they perceived.
<= /span>Clinic C had a figurehead charismatic leader, the first administrator, who played = an important role in legitimizing the clinic in its opening months. He was used by the owners to attai= n some purely instrumental goals of economic profit and was successful in maintain= ing his position of charismatic leadership as long as he did not use it to atta= in any real control over the operation of the clinic. The third administrator, who tried= to do this, came to grief.
<= /span>The third administrator tried to exercise his professional expertise and instit= ute a rational-legal decision making system.&n= bsp; However, he found his efforts stymied by the distant, all-powerful l= ay administrators. Their purely utilitarian values and instrumental method of administration through the bookkeeper created incongruence with the professional goals perceived and pursued by the public health administrator. The weakness of the medical direct= or as a force for professional values lent itself to the assumption of this role = by the new administrator, who saw himself as protecting those values and goals= .
<= /span>Clinic D operates almost strictly as a utilitarian organization with economic remuneration as its chief source of control. In that sense, there is not only no authority conflict but no administrative incongruence. If any exists, it is visited upon = the doctors, who must put aside their ascribed charisma as expert professionals while working in the clinic. = The organization is not serving professional goals in the broadest sense; it is serving instrumental goals. In that, it is highly effective.
<= /span>The cost, however, of forcing the professionals into a utilitarian structure is personal anxiety, fear, loss of self-esteem, alienation with respect to the management and coworkers, nonexistent loyalty, and instability. The professionals maintain their association with the clinic only by means of elaborate self-denial of its significance for their professional values.
Conclusion
<= /span>Abortion clinics are unique social organizations due to the controversial and emotio= nal nature of the service they provide. The first three clinics described as case studies illustrate a princ= iple common to them and perhaps to many others.= They demonstrate an important evolution in the organizational struct= ure and administrative style from normative and charismatic to professional and rational-legal. Administrative incongruence and authority conflict developed in all three because of dissension about organizational goals and differing rates of administrative change within the organizations.
<= /span>The consequences for the professional staff and employees for all three included tension, anxiety, and confusion. The quality of medical care may have been adversely affected in the process but evidence for this is lacking.
<= /span>The situation was not really better in the clinic with no authority conflict or significant administrative incongruence.&n= bsp; The technical quality of services provided was high although the deg= ree of emotional support for the patients was significantly less. Perhaps the only real conclusion t= o this study is this: the organizational structure may not be as important as the personalities and values of the people who are running it.
REFERENCES CITED
Burnhill,
M.S.
&nb=
sp; =
1975 Humane Abortion Services: A
Revolution in Human Rights and the Delivery of a Medical Service. &n=
bsp; =
; =
Mount
Sinai Journal of medicine 42:431-38.
Etzioni
A.
&=
nbsp; 1961 A Comparative Analysis of Co=
mplex
Organizations.
Goldhamer,
H., and Shils, E.A.
&=
nbsp; 1939 Types of Power and Status.
Hausknecht,
R.U.
&=
nbsp; 1973 Free-standing Abortion Clini=
cs: A
New Phenomenon. Bulletin of t=
he
&=
nbsp; Warren M. Hern is a physician who is
Director of the Boulder Abortion Clinic in Boulder,
Reprinted
from HUMAN ORGANIZATION, Volume 36, Number 4, Winter 1977, pp 376-383