The 131st Annual Meeting (November 15-19, 2003) of APHA

The 131st Annual Meeting (November 15-19, 2003) of APHA

3063.0: Monday, November 17, 2003 - 8:32 AM

Abstract #61329

Managerial decision making in a period of budget cutbacks: Implications for programmatic innovation in state health and human service agencies

Sanjay K. Pandey, PhD, Department of Public Policy & Administration, Rutgers University, 401 Cooper Street, Camden, NJ 08102-1521, 856-225-6359, and David M. Frankford, JD, School of Law, Rutgers University, 217 N. 5th Street, Camden, NJ 08102-1203.

Following Justice Brandeis’s 1932 coinage, states have often been described as “laboratories of democracy.” The applicability of the laboratory metaphor to the states, signifying an ability to conceive of, incubate and implement significant policy innovations, has given rise to some spirited debates in recent decades as it relates to state initiatives in health and social policy. Partly, states’ capacity to develop and follow policy innovations depends on the ability of managers in state health and human service agencies to undertake potentially risky activities. This paper will examine managerial perceptions about their work environment, specifically as they relate to their ability to undertake risks and pursue innovations. We also explore the influence of budgetary pressures on managers’ perceptions of flexibility in decision-making processes.

The data used for this study, funded by Center for State Health Policy and Forum for Policy Research and Public Service at Rutgers University, were collected under the auspices of the National Administrative Studies Project, a national survey of managers in state health and human service agencies. The survey questionnaire was developed with the aid of a review panel comprised of noted public management scholars during the summer of 2002. We used the American Public Human Services Administration Directory to construct the sampling frame. The survey administration began in fall of 2002 and is due to conclude soon having achieved a response rate of 52% at this time.

We will use the study findings to discuss some of the conditions necessary for states to pursue innovations in health policy and programs. Recent literature indicates that departmental managers are important change agents for programmatic innovation, particularly when change involves technical elements, generally outside the purview of public attention. Other work suggests that states can successfully innovate only in a resource-rich environment, and in particular when federal matching funds are available. Our data will enable us to explore the connection between these two literatures, or, in other words, between, first, the external environment, including resource availability, and managers’ willingness to take risks and act as change agents; and, second, between managers’ perceived ability to take risks and the extent to which programmatic change actually occurred. We anticipate that our findings will show that in a time of constraints, managers are unlikely to initiate change, which would, in any event, be difficult to accomplish in a hostile environment.

Learning Objectives:

Keywords: Health Departments, Health Care Reform

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Health Care Management Issues (Health Services Research Contributed Papers #1)

The 131st Annual Meeting (November 15-19, 2003) of APHA