Implementing a mental health case management system: Technological change and organizational structure

Case management is a technology for enhancing the continuity of care provided to clients in a community-based mental health service system. From among diverse case management models, the Massachusetts Department of Mental Health adopted the service broker model for statewide implementation and identified changes in the structure of inter-occupational and interorganizational relations in the agency that would be needed to accommodate this technology. This chapter analyzes the process of implementing this technology, based on interviews with administrators of mental health service areas during the implementation period. Potential obstacles to the implementation of a new technology are discussed and the resulting variation in adherence to the selected case management model is described. Sources of conflict about the case management model and effective responses to this conflict are identified. Conflict over the new model was strongest in areas where clinicians were most powerful and where boundaries around hospitals were strongest; such conflict was often resolved by subordinating case managers to clinicians and thus reversing the intended hierarchical structure. Implementation was facilitated by bridging strategies that facilitated cooperation among case managers and clinicians.