Organizational transformation of a community‐based clinic

This article reports a case study of the planned transformation of a volunteer‐run community crisis‐care center into a community clinic. The data for this study are drawn from organizational records and participant observation. During the transformation, the clinic had to plan an orderly transition from volunteer to paid staff, from paper records to an integrated management information system, from primarily crisis care to chronic care, from primarily (physical) medical care to integrated case management. Along the way, some of the planned activities proved impossible to implement, some of what turned out to be key events were completely unanticipated, and many activities were finally accomplished but in a fashion very different from what was proposed in the plan. Four lessons were drawn from this case. First, as much as the caseload increased, the need for supportive services grew at a much faster rate. Second, the case demonstrates the need to develop productivity benchmarks that are speci.c to the group being served. Third, the case demonstrates the need for .exibility to go “off plan” to accomplish a larger goal. Fourth, the case illustrates how “big money” and rapid growth can threaten the sustainability of an organization. “What we think of as idyllic only looks that way to sightseers from other places, and other times.” —Carolyn Heilbrun, The Last Gift of Time