This is a study of the impact of social organization on the behavior of Nurses and Social Workers practicing in a health care delivery system in a country in Upstate New York. Focused interviews were administered to 147 respondents, to explore suggestions in the literature concerning the determinants of professional behavior in organizations, and to find cues that would lead to better measures for future studies. The interview instrument was developed for this work as were the three hypothetical case studies which it includes. Eight definitions of health were derived from the literature and measured by respondent choices in relation to their education and practice experiences and referral responses to three case studies.

The specific questions this study posed are: Is there a professional definition, or concept, of health which is developed through the educational socialization of nurses and social workers which can be identified in self-report measures? Is the professional definition of health modified through the organizational socialization within a specific health care delivery setting? And, if there are reported differing definitions, do these differences modify health care transactions in any discernable patterns, as evidenced in an assessment of client referral decisions?.

Data from this work show evidence of professional socialization into a health paradigm. There is also strong evidence that further socialization occurs in the organization of practice. Referral decisions were measured by respondent choices of health definitions, organizations of practice, profession, and personal characteristics. We found that referral is a function of many variables, however, there is strong evidence that referral is dependent on the type (medical, private, or government) of agency in which professionals practice. And, that although we know from our research that bureaucratic organizations control behavior through formal policies and procedures, our respondents report an informal process which can be viewed as self-conscious attention to a second level behavior among professionals which, according to these data, is substantial. We found further that the concept of health is not universally defined in one paradigm and that referral actions are in some way modified by the specific health definition which each professional applies to her or his referral decisions.