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Abstract: This case examines efforts to decentralize the administration of health programs in New York City, focusing particularly on the actions of the John Lindsay administration (1965-73). Part A begins with a short history of administrative reform efforts in New York's Department of Health, from 1916-65. It then outlines changes wrought by the election of Mayor Lindsay, including the appointment of Joseph Cimino and Alan Gibbs as commissioner and deputy commissioner of Health. Part B traces the Department's decentralization during Cimino and Gibbs' tenure. In particular, the case outlines the structural reorganization that Gibbs supervised, and the concomitant changes in personnel, finances, and management control. The authors also detail Cimino's strategy when countering political and bureaucratic resistance to Gibbs' changes. The case concludes with an epilogue, noting that much of Cimino and Gibbs' decentralization efforts were reversed after the 1973 mayoral election, when Abraham Beame came into office.
Learning Objective: This case may be used as a vehicle to discuss organizational structure. New York's experience demonstrates the pros and cons of a functional, versus a geographic, structure for a government service agency. It also indicates the political obstacles to bureaucratic restructuring.