The organizational consulting profession and its practitioners are analyzed to discover the dynamics which include or exclude social responsibility in the consultant-client relationship. This relationship is targeted within the healthcare industry and its particular impacts on managed care reform. Perspectives are researched and examined at the intrapersonal, interpersonal, organizational, interorganizational,industry, inter-industry, and societal levels.

The concept of "social responsibility" evolved in this study from distilling the major voices, or discourses, across a broad array of literature. Deconstruction of normative literature within the field of organizational consulting revealed the institutions in power at the time of publication (Foucault, 1970), and the chasm between "social responsibility" and normative consulting. The elite nature of the profession surfaced, in terms of how "what is present, what is privileged, depends on the absent other that it seeks to dominate and erase" (Hollinger, 1994). Potential for social responsibility in the field comes from those discourses which are non-normative, and/or which may also be entirely outside the field (Berry, 1993; Boje, Gephart & Thatchenkery, 1996; Edwards, 1996; Freire, 1970; Hochschild, 1983). A graphic vision is proposed of the "Chain of Social Responsibility", and the integrity of the entire chain and its five "links" depend upon open discourse across society (Collins & Skover, 1996).

Thirty-eight qualitative interviews were conducted including: twenty organizational consultants from various firms, eleven healthcare clients from all aspects of the industry, and seven organizational theorists. Data were also collected on the organizations represented, and comparisons made between consulting organizations, between healthcare organizations, and the impacts the industries may have on each other. Specifically, the discourses of the individuals, their organizations, and the two industries were deconstructed to discover how discourse reveals whether social responsibility is valued or not.

Results indicated: (a) The consultant-client relationship is an elite, sealed system of power and privilege which has changed and continues to change the healthcare industry; (b) Consultants' and clients' discourses reflect a wide range of values - from strong integrity and social responsibility in their work, to conflicted values with little to no senseof social responsibility in their work.

Factors which contribute to this spectrum are thoroughly explored based on the data; (c) The nature of the field of organizational consulting itself - its unregulated practices, its lack of consistency in the education of consultants, and its dominant voices coming from the major consulting firms with their positivist discourse - presents serious roadblocks to the profession=s demonstration of social responsibility; (d) The healthiest client organizations with the strongest leadership use consultants minimally or not at all; while the least healthy client organizations with the weakest leadership rely on the use of too many consultants, which sets a vicious circle in motion of organizational deterioration; (e) Finally, organizational consultants are enjoined to consider how they have allowed the profession=s roots in the social sciences to become defiled by a focus on elite economic interests over the needs of the human condition, as typified by the changes which organizational consulting has implemented within the healthcare industry.