The NHS and Community Care Act instituted a fundamental split between the purchasers and providers of health care; shifting the NHS from a bureaucratic process driven organisation to one which is market led and output orientated. This paper explores cultural change and implementation strategies in a major first wave Trust. The case study is a story of struggle woven around the vision and determination of the Chief Executive to create a new style NHS through second order cultural change. The organisation has over 8,000 employees, many long servers with entrenched views and diverse professional backgrounds.
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