Date of Award

5-1979

Document Type

Thesis

Degree Name

Master of Science

First Advisor

John McClusky

Second Advisor

Lawrence M. Millner

Abstract

This paper by Edward M. Peters explores the organizational design of ambulatory care services within the Department of Health and Hospitals in St. Louis, driven by a grant from the Robert Wood Johnson Foundation's Municipal Health Services Program. It begins by detailing the current challenges within St. Louis’s health department structure, emphasizing the need for integrated, neighborhood-based healthcare services to serve underserved communities.

Peters examines three organizational models: maintaining the current structure, adopting a hospital-based approach, or establishing a dedicated ambulatory care division. The analysis emphasizes the limitations of the current health center model, which relies heavily on categorical programs and lacks cohesive authority and responsibility for primary care delivery. The hospital-based model, while allowing integration with existing acute care services, raises concerns about overshadowing ambulatory care’s specific needs within a large, complex organization.

The proposed ambulatory care division stands as a new structural entity within the department, tasked solely with the administration and coordination of outpatient care, with clear delineation among medical, nursing, and administrative roles. Peters advocates for this model using classical management theory, highlighting the need for authority, specialization, and unity in direction to effectively manage resources and fulfill the program's goals. Ultimately, the paper suggests that establishing a separate ambulatory care division offers a more effective organizational solution, allowing St. Louis’s health services to address growing healthcare needs with a dedicated focus on accessible, high-quality, and sustainable outpatient services.

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