The Urban HSA, the case study site, is located in a large metropolitan area with a diverse population and an intricate political structure. The agency's history provides a vivid illustration of the latter observation in that the first attempt at constituting an HSA in this area failed. Those in a position to "designate" (approve) it said it was inappropriately constituted because it was obviously composed of the cronies of the local political establishment. Thus, an entirely new HSA had to be created in 1976, two years after the relevant legislation went into effect. The result is that the Urban HSA was not fully staffed and operative for another year or so. In effect, it had been functioning for about three to four years before the shift in the national social climate occurred that brought with it the anti-regulatory stance espoused by the Reagan administration. This is the point at which I asked the Urban HSA for permission to study it.
The staff members were open and accepting of my interest in their work. The first day I arrived, in January, 1982, I was introduced to the people holding administrative positions. I was assigned to one person, the person responsible for CON reviews, who more or less taught me her job. My intention was to become acquainted with the agency and its work before deciding how to proceed in answering the question that the agency's representatives and I had agreed would be the focus of my research, namely, what have we learned from our experience with health planning?
In order to familiarize myself with the agency's work, I spent approximately two and one-half days per week for the first few months reading material in the files, including documents produced by the state and the region elaborating on the law, the regulations, and statutes; past staff reports; annual reports; and so on. I participated in staff sessions in which incoming CON proposals were reviewed. Finally, I attended the monthly meetings of the CON committee and the governing board. The meetings ran for approximately three to four hours. (Occasionally meetings were canceled if the business at hand could be carried over to the next month.) Additional special meetings were called when special problems warranted them.
After approximately six months of participant observation in the agency's work, I