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An Analysis of the Consolidation of Louisiana's Health and Welfare Agencies

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An Analysis of the Consolidation of Louisiana's Health and Welfare Agencies University of Massachusetts Amherst ScholarWorks@UMass Amherst Doctoral Dissertations 1896 - February 2014 1-1-1979 The effects of reorganization : an analysis of the consolidation of Louisiana's health and welfare agencies. Mary Karen O'Brien University of Massachusetts Amherst Follow this and additional works at: https://scholarworks.umass.edu/dissertations_1 Recommended Citation O'Brien, Mary Karen, "The effects of reorganization : an analysis of the consolidation of Louisiana's health and welfare agencies." (1979). Doctoral Dissertations 1896 - February 2014. 1906. https://scholarworks.umass.edu/dissertations_1/1906 This Open Access Dissertation is brought to you for free and open access by ScholarWorks@UMass Amherst. It has been accepted for inclusion in Doctoral Dissertations 1896 - February 2014 by an authorized administrator of ScholarWorks@UMass Amherst. For more information, please contact [email protected]. THE EFFECTS OF REORGANIZATION: AN ANALYSIS OF THE CONSOLIDATION OF LOUISIANA'S HEALTH AND WELFARE AGENCIES A Dissertation Presented By Mary Karen O'Brien Submitted to the Graduate School of the University of Massachusetts in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY May, 1979 The Department of Political Science Copyright by Mary Karen O'Brien 1979 All Rights Reserved ii : THE EFFECTS OF REORGANIZATION: AN ANALYSIS OF THE CONSOLIDATION OF LOUISIANA'S HEALTH AND WELFARE AGENCIES A Dissertation by Mary Karen O'Brien Approved as to style and content by GlenGordon, Department Head, Political Science Department ACKNOWLEDGMENTS I am especially Indebted to Professor Lewis C. Mainzer for his advice, criticisms, and encouragement during the writing of this dissertation. I am also indebted to Profes- sors Robert A. Shanley of the Department of Political Science and Bruce Stuart of the Department of Public Health. They read the thesis and offered valuable suggestions. iv ABSTRACT THE EFFECTS OF REORGANIZATION: AN ANALYSIS OF THE CONSOLIDATION OF LOUISIANA'S HEALTH AND WELFARE AGENCIES May, 1979 Mary Karen O'Brien, B.A., University of New Orleans M.A., Louisiana State University Ph.D., University of Massachusetts Directed by: Professor Lewis C. Mainzer In 1973, fifty-nine health and welfare agencies in Louisiana were consolidated under one large umbrella department. Included in this consolidation were the depart- ments of health, welfare, and hospitals; two hospitals which operated independently of the hospital department; and several boards and commissions. The purpose of this case study is to determine what effect that reorganization has had on: 1-the structures of the reorganized agencies, 2-the personnel of those agencies, 3-the decision-making and management procedures in the new department, H-the v outputs (i.e., the policies, programs and services) of the consolidated department; and 5-the political-administrative environment in which the department operates. In each instance, the question that has been asked is: Has reorgan- ization made any difference? Based on the findings of this study, it cannot be said that the Louisiana reorganization was a great success. It has not saved the state millions of dollars as its supporters predicted; nor has it resulted in improved health and welfare services. Nevertheless, the Louisiana reorganization has had important consequences. It has given the governor greater leverage in dealing with the state bureaucracy, and it has also allowed a limited reassessment of the state's health and welfare policy. Interestingly, the governor's espousal of reorganization has gained him support with taxpayers as well as users of the health-welfare system. The poor and the needy of the state were gratified by the governor's concern for the quality of health and welfare services. In addition, blacks supported the governor's appointment of blacks to key positions in the department. Those appointments seemed to symbolize the governor's commitment to greater black participation in state government. Thus, while it cannot be said that reorganization has achieved all that was predicted for it, the fact is vii that reorganization has made a difference in Louisiana. Whether or not the state reorganized its health and welfare agencies obviously mattered to the governor, the legislators, clientele, the public, and the providers of the state's health and welfare services. Because of this, it might be concluded that the greatest impact of this reorganization was not in the administrative realm, but in the political realm. TABLE OF CONTENTS ACKNOWLEDGEMENT INTRODUCTION Chapter I. A REAPPRAISAL OF THE STATE ADMINISTRATIVE REORGANIZATION MOVEMENT 6 Introduction 6 Origins of the Movement 8 The growth of state government in the nineteenth century, 8-Political corrup- tion and the goal of responsible govern- ment, 10-The drive for economy and efficiency, 11-The standards of state reorganization, 13 Why State Reorganization Efforts Have Not Been More Effective 18 State Reorganization in the Seventies ... 31 Factors contributing to the renewed interest in reorganization, 31-Trends in state reorganization activity, 39 Conclusions 47 Notes 51 II. BACKGROUND TO THE 1973 LOUISIANA REORGANIZATION 58 Introduction 58 viii ix Failure of Earlier Reorganization Efforts . 59 The Emergence of Reorganization As a Campaign Issue 67 The McKeithen Administration, 67- Factional instability, the black vote and voter unrest, 71-The primary campaign, 76 The Edwards Reorganization Plan 78 Initiation of the reorganization plan, 78-General reaction to the plan, 80-Reaction to the health- welfare proposal, 82 The Department of Health, Social and Rehabilitation Services 87 Agencies included in the consolidation, 87-Powers and functions of the new department, 90-Transition phase, 92 Conclusions 9^ Notes 96 III. THE EFFECT OF THE REORGANIZATION ON AGENCY STRUCTURES, DECISION-MAKING PROCEDURES, AND PERSONNEL 102 Introduction 102 Integration of Agency Structures 105 Decision-Making in the Umbrella Department 118 Reorganization's Effect on Agency Personnel 130 Conclusions 136 Notes x 39 IV. THE POLITICAL-ADMINISTRATIVE ENVIRONMENT AND THE HEALTH-WELFARE REORGANIZATION W ^ Introduction - X Governor Edwards, the Commissioner of Administration and LHSRSA 146 The Legislature and the Umbrella Department 162 Interest Groups, Clientele and LHSRSA . 166 Conclusions 171 Notes * I74 V. THE EFFECT OF THE 1973 REORGANIZATION ON THE OUTPUTS OF THE HEALTH-WELFARE SYSTEM . 177 Introduction 177 The Effect of Reorganization on Total Spending 177 The Effect of Reorganization on Established Programs 183 Policy Changes Since Reorganization . 192 Conclusions 198 Notes 201 VI. WHAT DID REORGANIZATION IN LOUISIANA ACTUALLY ACCOMPLISH? 203 SELECTED BIBLIOGRAPHY 212 LIST OP TABLES 1. Number of Personnel in LHSRSA 136 2. Appropriations for the Division of Management 158 3. Personnel Granted the Division of Management 158 k. Expenditures for LHSRSA 179 5. LHSRSA Expenditures After Adjusting for Inflation 180 6. Comparison of Federal and State Expenditures as Percent of Total LHSRSA Budget l8l 7. Comparison of Federal and State Funding to LHSRSA After Adjusting for Inflation ... l8l 8. Comparison of Budget Totals for Divisions of LHSRSA 184 9. Comparison of Budget Totals for LHSRSA Divisions Using Inflation Adjusted Figures 187 10. Trends in Occupancy for the State General Hospitals 19^ 11. Trends in Occupancy for the State General 19^ Hospitals (Excluding Charity Hospital). xi INTRODUCTION Over the past seventy years, administrative reor- ganization has become a major field of interest for stu- dents of public administration and state government. The literature is particularly rich in that it contains many useful case studies showing how reorganization decisions are made. Those studies include the Inter-University Case Program (commonly called the ICP series) 1 as well as the collections by Harold Stein 2 and Frederick Mosher3 (the latter focuses entirely on case studies of adminis- trative reorganization of state governments). Most of those studies found that there is a great deal of politics involved in making reorganization decisions. Contrary to the rhetoric of the early re- formers, the question of organization structure is not a technical matter that political actors are content to leave in the hands of the professional bureaucrats. The reason for this lies in the fact that the determination of organization structure may be important in deciding which interests will receive greater emphasis in the pol- itical system. In practical terms, this means that the choice of organizational structure may affect decisions on budgets, programs, or personnel. Since reorganization 1 2 represents an attempt to change organizational structures/ one can readily understand bureaucratic reluctance to re- organize. And, as case studies have shown, this bureau- cratic reluctance can produce reorganization debates which are protracted and often very bitter. But what happens after a reorganization plan has been approved by a legislature? Given the intense struggle involved in the reorganization process, it is difficult to believe that all combatants will accept the reorgani- zation decision as final. It would seem more likely that they will continue to fight to obtain the organizational structures which they believe will be most beneficial to their interests. A major limitation of much of the existing reor- ganization literature is that it fails to provide a sys- tematic analysis of the effects of reorganization. The authors of the reorganization
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