Decision-making in a time of significant reform: managing in the NHS

Abstract

This article utilizes three empirical studies to examine the organizational and policy context within which health managers find themselves today, asking three questions of extreme relevance for the area of health organizational reform in a period in which the pace and scope of change are intense: What strategies do public service managers employ to make sure they stay up to date with what is required of them? How do public service managers deal with the insight that much of what they are accountable for is actually outside of their control? And when a demanding and prescriptive performance measurement system is introduced, how does it affect public service managers? The article considers a range of organizational settings, looking for commonalities in the problems that managers face and the strategies they employ to attempt to deal with them. Linking its findings with previous studies, it suggests a number of implications for the future of management in the National Health Service.