Describes changes in the organization of the NHS towards a trust‐based system and explains that these changes have devolved decision making downwards. Points to the importance of strategic planning for the survival of hospital trusts and notes that strategy should be developed by doctors and managers working together. Outlines management concepts and theoretical constructs underpinning strategic decision making, applying them to the NHS. Concludes that the professionalization of NHS management has shifted power from doctors towards generalist managers but that there is evidence suggesting the value of clinicians as decision makers, given the right skills and an understanding of factors affecting decision processes.
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