Transformation from informal community group to community-based health care organization: a case study of change

Abstract

The purpose of this study was to examine the transformations of the organization, AID Atlanta in it's first ten years to determine how and why decisions were made which lead from an informal community group to the creation of the successful, viable, community-based health care organization. Case study methodology was used to conduct I the investigation. Sources of data included primary and secondary documents, direct observations, and systematic interviewing. The theoretical framework for this study was the theory of dissipative structures, as developed by Prigogine (1976) and others within the tields of biology and chemistry. A number of social scientists have applied this theory to the study of organizational change and transformation. The theory conceptualizes organizations as open systems that exchange energy with the environment, are ·self determining, and self organizing. Change is conceived as a normal response to an uncertain artd complex environment. The study found that AID Atlanta underwent a series of changes and transformations which enabled it to grow, survive and remain viable. Forces influencing the organization came from both the internal and external environment, with the most powerful force being the AIDS epidemic. Decisions were made by numerous individuals which served to shape the success of the organization. The clear and constant mission of the organization was a positive sustaining force, and the development of linkages to the community was a key factor in securing necessary resources. Implications of the study are that decision makers in community-bas.ed health care organizations must expect and prepare for change. Knowledge of the dxperiences of I similar successful organizations may lead the administrator to develop st~ategies which may serve to promote their own success. Strategies shown to promote viability in this study included an open exchange with the internal and external environments, a willingness to change, the use of resources from external connections, articulation of a vision ba.$ed on the mission, knowledgeable and experienced leaders, .and a strong foundation and heritage.