The article utilises contrasting heuristical perspectives ‐ contingency and political theory ‐ to help throw light on aspects of managerial effectiveness at an NHS Trust hospital in the UK. This reveals differences in the way in which managerial effectiveness is configured and understood. It utilises a qualitative case study approach. Data were collected by semi‐structured interview from different stakeholders, particularly general managers and clinical managers. It may be relevant to other public sector organizations in the UK and elsewhere. It concludes that managerial effectiveness is complex, subjective and more about difference than objective rationality. It recommends that managers pay more attention to political awareness, skills and understanding.
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