Understanding Change in the NHS

This paper presents a novel and distinctive approach to the study of change within the NHS. Central to the paper's approach is the view that research on change in health care systems should be processual, comparative, pluralist, and historically based. Guiding such a view is a meta-analytical framework which contends that theoretically sound and practically useful research on change should involve the continuous interplay between ideas about the context, the process, and the content of change together with skill in regulating the relations between the three (Pettigrew 1985a, 1985b). The paper has five sections. Section one examines some of the contemporary pressures for change in the NHS and draws attention to the gap which often exists between statements of strategic intention and their operational implementation. Section two reveals our distinctive analytical approach to the study of service changes and clarifies the theoretical underpinnings of our work. Section three offers an extended critical review of recent research and writing on change in health care organizations. Section four summarizes our findings from the literature review and reaffirms the novelty and significance of our chosen approach. Section five provides an overview.