Managing Ambiguity. A Study of the Introduction of General Management in the NHS

The central focus of this thesis is managing change in the National Health Service (NHS). In particular it considers the introduction of general management into the NHS - its third major reorganization and one based on the recommendations of a team of businessmen led by Sir Roy Griffiths, then managing director and deputy chairman of Sainsburys foodstores. More than previous reorganizations of the NHS in 1974 and 1982, the Griffiths changes were a conscious attempt to move away from a "boxes and charts" approach to organizational change to one which sought to disturb organizational processes and ultimately to change the beliefs and values of NHS actors. The thesis attempts to illuminate the implications of what was viewed as a significant change in the way the NHS was managed, in three ways. Firstly it reviews the existing empirical work on health service management and considers what can be learnt about the difficulties of introducing change in the NHS. Secondly it reports fieldwork data from twenty NHS districts which explores the actions and priorities of twenty newly appointed DGMs with a variety of different occupational backgrounds as they sought to implement the agenda for change spelt out in the Griffiths Report. The thesis reports a significant gap between the aspirations of the Griffiths Report and what the introduction of general management was able to deliver and a number of unintended consequences. Thirdly the thesis draws on the work of Norbert Elias known as figurational or process sociology in an attempt to illuminate the fieldwork data further. Elias is not a sociologist one associates with the study of the NHS, or indeed the management of change, yet it is argued that his writings offer much to those wishing to explore organizational and management issues in the NHS.