Skip to main content
Article thumbnail
Location of Repository

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

By Susan Elizabeth Dopson


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.\ud 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.\ud 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

Publisher: University of Leicester
Year: 1994
OAI identifier:

Suggested articles


  1. (1965). (1842) Report on the Sanitary Conditions of the Labouring Population, England. Local Reports Reprinted by Edinburgh
  2. (1944). A National Health Service,
  3. (1975). A Note on Method in the Sociological Study of Sport'. In
  4. (1984). A Score of MPs Debate Griffiths'.
  5. (1987). A Study of the Implementation of General Management: Executive Summary.
  6. (1977). A Survey of Public Knowledge in Relation to the National Health Service Reorganization'.
  7. (1987). A Viewpoint: Things to Come: the NHS in the Next Decade'.
  8. (1985). Academic Finding Out in Management'.
  9. (1988). Accountable Management in British Central Government: Some Reflections on the Official Record'.
  10. (1978). Allocating Health Resources: A Commentary on the Report of the Resource Allocation Working Party.
  11. (1984). An elaboration of the reactions of interest groups to the Griffiths
  12. (1981). Another Dose of Managerialism'.
  13. (1976). Aspects of Illness.
  14. (1988). Association of Community Health Councils for England and Wales
  15. (1991). Between an Ideological Rock and an Organizational Hard Place:
  16. (1983). Case and Situation Analysis'.
  17. (1975). Case Study and Theory in Political Science'.
  18. (1984). Case Study Research,
  19. (1986). Changes in Planning Coping with Health Service Finances Managing with Doctors Multidisciplinary Management Dealing with Region and Department In Pursuit of Quality: the DGM and the development of quality assurance Article, Health Service Journal
  20. (1982). Choices for the Manager: A Guide to Managerial Work and Behaviour.
  21. (1989). Civilization and the Human Self-Image.
  22. (1978). Class struggle: The State and Medicine.
  23. (1984). Clinical Uncertainty: Is It a Problem in the Doctor-Patient Relationship? '.
  24. (1986). Coalition and Decision-Making Within Health Districts.
  25. (1979). Commission on the National Health Service
  26. (1968). Commitment to Welfare. Allen and Unwin.
  27. (1980). Community Health Council Participation in the NHS Planning System'.
  28. (1982). Concepts of Illness Causation and Responsibility: Some Preliminary Data from a Sample of Working Class Mothers'.
  29. (1974). Conflict and Conflict Resolution in DoctorPatient Interactions'.
  30. (1987). Conflict Management and Organizational Development.
  31. (1982). Consensus Decision-making in the National Health Service: a Review'.
  32. (1988). Consumerism and the Public Sector. How Well Does the Coat Fit?
  33. (1980). Contexts of Scientific Discourse: Social Accounting Experimental Papers'. In
  34. (1976). Contrasts in Management: A Study of Different Managers' Jobs: Their Demands or Choices.
  35. (1979). Control, Participation and the British National Health Service'.
  36. (1980). Coping with Uncertainty,
  37. (1979). Coping with Uncertainty, Decisions and Resources Within Health Authorities'.
  38. (1992). Crisis and Opportunity in Health Service Management'.
  39. (1970). Criticism and the Growth of Knowledge.
  40. (1984). Deconstruction of Evaluation Research, Pt. II, The Way Back? '.
  41. (1975). Degrees of Freedom" and The Case Study'.
  42. (1989). Designing Quality Research.
  43. (1977). Disabling Professions.
  44. (1985). District Health Authorities in Action: Two Years on.
  45. (1983). District Health Authorities in Action.
  46. (1988). Doctors and Managers: Never the Twain Shall Meet? '
  47. (1966). Doctors and State Medicine: A Study of the British National Health Service.
  48. (1990). Doing Business in the Temple? Managers and Quality Assurance in the Public Services'.
  49. (1991). Elias and the Politics of Theory'.
  50. (1958). English Health Service,
  51. (1991). Evaluating Elias'. Theory,
  52. (1984). Far from Pleased on Griffiths'.
  53. (1988). For Better or Worse? Assessing
  54. (1973). For Sociology.
  55. (1986). Formalization and Informalization: Changing Tension Balances in Civilizing Processes'.
  56. (1988). General Management in a District Health Authority'.
  57. (1991). General Management in the NHS: The Initial Impact 1983-88'.
  58. (1981). General Practice Revisited.
  59. (1979). Genesis and Development of a Scientific Fact'.
  60. (1982). Getting it Right? The
  61. (1989). Griffiths and the Nurses: A National Survey of CNAs.
  62. (1988). Guy's Hospital 1985-1988: A Case Study. London, unpublished paper produced for the King's Fund International Fellowship series.
  63. (1971). Health and Sickness: The Choice of Treatment.
  64. (1976). Health and Social Security
  65. (1979). Health and Social Security and Welsh Office
  66. (1975). Health Care Politics. Chicago Illinois:
  67. (1982). Health Policy in Britain.
  68. (1991). Health Service Management -a Sociological View: Griffiths and the Non-negotiated Order of the Hospital'.
  69. (1988). Historical Methods and Organizational Analysis: the Case of the Naval Dockyard'.
  70. (1984). Hooligans Abroad. Routledge and Kegan Paul.
  71. (1990). Human Resource Management in the Public Sector'.
  72. (1989). Impact of the Griffiths Reforms of National Health Service Management: the Views of Psychiatrists'.
  73. (1986). Implementing Griffiths at District Level.
  74. (1982). In Search of Excellence: Lessons from America's Best-Run Companies.
  75. (1984). In the Field: An Introduction to Field Research. Allen and Unwin:
  76. (1969). Induction and Intuition in Scientific Thoughts.
  77. (1979). Industrial Relations in the NHS: The Search for a System. London: King's Fund.
  78. (1992). Industrial Relations in the NHS.
  79. (1985). Initiative and Inertia: Case Studies in the NHS. The Nuffield Provincial Hospitals Trust.
  80. (1965). Interviewing - Its Forms and Functions.
  81. (1982). Introduction to Social Research.
  82. (1987). Involvement and Detachment.
  83. (1979). is the NHS Really in Crisis? '.
  84. (1986). Isn't It Difficult to Support Some of the Notions of "The Civilizing Process"? A Response to Dunning'. In
  85. (1985). Keeping the District Family Happy'.
  86. (1986). Labour Relations in Health Services Management',
  87. (1989). Leading in the NHS: A Practical Guide.
  88. (1983). Letter to Health Authority Chairmen, November 18th. your objectives? Which oup of staff have you been spending most time with?
  89. (1975). Limits to Medicine.
  90. (1973). Management Arrangements for the Reorganised NHS,
  91. (1991). Management Teams. Why They Succeed or Fail.
  92. (1990). Managerial Roles and Relationships. The Impact of the Griffiths Report'.
  93. (1990). Managerialism and the Public Services: The Anglo-American Experience.
  94. (1988). Managers and Their Jobs: A Study of the Similarities and Differences in the Way Managers Spend Their Time.
  95. (1976). Managing Health Resources: English Style'.
  96. (1986). Managing Health Services: Health Authority Members in Search of a Role.
  97. (1988). Managing Strategic Service Change in the NHS.
  98. (1986). Managing the National Health Service in Scotland: Review and Assessment of Research Needs.
  99. (1988). Managing the National Health Service: Shifting the Frontier?. London:
  100. (1988). Medical Dominance in Britain: Image and Historical Reality'. The Milbank Quarterly,
  101. (1974). Medical Knowledge and the Patronage System in
  102. (1988). Microcomputer Applications and Qualitative Research.
  103. (1956). Ministry of Health
  104. (1966). Ministry of Health and Scottish Home and Health Department
  105. (1961). Models of Bureaucracy Which Permit Conflict'.
  106. (1964). Modem Organizations. Englewood Cliffs:
  107. (1990). Modern Organizations: Organization Studies in the Post-Modern World.
  108. (1988). More Power to the Units',
  109. (1971). Muddling Through: Planning for Health Care in England'.
  110. (1972). National Health Service Reorganisation:
  111. (1978). Negotiations.
  112. (1975). New Bottles: Old Wine?
  113. (1988). New Model Management: Griffiths and the NHS. Nursing Policy Study Centre,
  114. (1976). New Structures for Old'. In
  115. (1986). NHS Management and the Griffiths Report.
  116. (1983). NHS Management Inquiry (The Griffiths Report).
  117. (1989). Notions of Success in General Management'.
  118. (1968). Observation: Social Observation and Social Case Studies'.
  119. (1983). Occupational Monopoly and Modern Medicine.
  120. (1973). On Limitations of Modem Medicine'.
  121. (1979). On the Analysis of Observational Data: a Discussion of the Worth and Uses of Inducive Techniques and Respondent Validation',
  122. (1984). Once More With Feeling: The Griffiths Report and Personnel'.
  123. (1988). Organizational Culture: Origins and Weaknesses'.
  124. (1989). Organizations, Culture and the Management of Change in the NHS.
  125. (1989). Other Cultures.
  126. (1969). Participant Observation and the Collection and Interpretation of Data'.
  127. (1961). Patients' Views of Medical Practice.
  128. (1975). Patterns of Discovery.
  129. (1974). Planning in Health Care - The Approach in a Reorganized NHS. '
  130. (1983). Plans and Practice: the Participants' Views'.
  131. (1981). Policy-making in the National Health Service.
  132. (1989). Politics and Planning in the NHS.
  133. (1983). Politics of the National Health Service.
  134. (1975). Power and Authority in Public Schools (1700-1850)' Working Papers in Historical Sociology,
  135. (1970). Power and Poverty: Theory and Practice. London,
  136. (1986). Power and the Division of Labour.
  137. (1981). Power in Organizations.
  138. (1988). Power in the Health Service: the Effects of Reorganization on Professions and Bureaucracies.
  139. (1974). Power: A Radical View.
  140. (1979). Practice, decisions and resources in the National Health Service,
  141. (1960). Pressure Group of Politics, Allen and Unwin.
  142. (1984). Problems and Solutions: The Perceptions of NHS Managers'.
  143. (1956). Problems2off Involvement lvement and Detachment'.
  144. (1987). Professional Nursing Advice After Griffiths - An Interim Report. Nursing Policy Study Centre,
  145. (1980). Professional or Public Health? Sociology in Health and Medicine. London: Nuffield Provincial Hospitals Trust.
  146. (1975). Professionalism in Formal Organizations'.
  147. (1966). Professionals and Bureaucracies: Areas of Conflict'.
  148. (1983). Professionals in Bureaucracies: The Conflict Thesis Revisited'.
  149. (1972). Professions and Power,
  150. (1970). Professions or Self-Perpetuating Systems: Changes in the French University-Hospital System'.
  151. (1990). Public and Private Sector Management: The Case for a Wider Debate'.
  152. (1983). Public Management, Private and Public Perspectives.
  153. (1988). Public Management: A Third Approach? '.
  154. (1987). Qualitative Analysis for Social Sciences.
  155. (1972). Qualitative Analysis: Historical and Critical Essays. Allyn and
  156. (1984). Question Time for Griffiths'.
  157. (1985). Reflections on the Management of the National Health Service. Nuffield Provincial Hospital Trust. Occasional Papers 5.
  158. (1979). Reflections on the Royal Commission'
  159. (1977). Relationships and Communications'.
  160. (1979). Reorganizing the National Health Service: A Case Study of Administrative Change.
  161. (1984). Reorganizing the National Health Service: An Evaluation of the Griffiths Report. Social Organization Ltd.
  162. (1968). Report of the Committee on Local Authority and Allied Personnel Social Services
  163. (1959). Report of the Maternity Services Committee (Chairman, Earl of Cranbrook).
  164. (1966). Report of the Royal Commission on Local Government in
  165. (1982). Research as Action: An Experiment in Utilizing Social Sciences'.
  166. (1991). Research Methods for Managers.
  167. (1987). Research Unit, Ruskin College for the Confederation of Health Service Employees,
  168. (1977). Responses to Norbert Elias's Work in England, Germany, the Netherlands and France'.
  169. (1979). Restructuring the Health Service.
  170. (1962). Review Committee
  171. (1947). Scientific Management. Harper and Row.
  172. (1985). Secrets of Success for Happy Families'.
  173. (1991). Seven Years of Progress -General Management in the NHS.
  174. (1992). Shaping Strategic Change.
  175. (1942). Social Insurance and Allied Services.
  176. (1984). Social Services Committee
  177. (1989). Society as Process. A bibliography of Figurational Sociology in the Netherlands.
  178. (1985). Sociological Approaches to Health and Medicine.
  179. (1993). Sociology and Organization Theory: Positivism, Paradigms and Post-Modernity.
  180. (1969). Sociology and Psychiatry'.
  181. (1986). Sociology as Applied to Medicine. Bailliere Tindall.
  182. (1971). Sociology of Knowledge: New Perspectives'.
  183. (1986). Starting from Scratch'.
  184. (1979). Still Muddling, Not Yet Through',
  185. (1985). Strategic Management in Public and Private Organizations.
  186. (1975). Strategies of Social Research. The Methodological Imagination'.
  187. (1950). Studies in the Genesis of the Naval Profession'.
  188. (1961). Suggestions for a Sociological Approach to the theory of organizations'.
  189. (1979). Team Management in the NHS: What is it all about? ' Health and Social Services Journal,
  190. (1983). Teams and Top Managers in the NHS: A Survey and a Strategy.
  191. (1985). Teams with Regional Accent'.
  192. (1989). The Age of Unreason'.
  193. (1973). The Analysis of Bureaucratic - Professional Conflict: Functional Versus Dialectical Approaches'.
  194. (1976). The Bi-furcation of Rugby Union and Rugby League: A Case Study of Organizational Conflict and Change'.
  195. (1973). The Birth of the Clinic.
  196. (1980). The Buck Stops Where? Accountability and Control in the National Health Service.
  197. (1980). The Case for Qualitative Research'.
  198. (1989). The Changing Character of the Medical Profession: a Theoretical Overview',
  199. (1939). The Civilizing Process,
  200. (1982). The Civilizing Process, State Formation and Civilization,
  201. (1984). the Clinical View'
  202. (1955). The Concept of Property-Space in Social Research'.
  203. (1967). The Creation of the National Health Service. London: Routledge and Kegan Paul.
  204. (1977). The Diaries of a Cabinet Minister: Volume 3;
  205. (1979). The Direction of Medical Research'.
  206. (1967). The Discovery of Grounded Theory.
  207. (1980). The District Administrator in the National Health Service. London: King Edward's Hospital Fund.
  208. (1990). The Dynamics of British Health Policy. London: Unwin Hyman.
  209. (1965). The Established and the Outsiders: A Sociological Enquiry into Community Problems.
  210. (1973). The Financial Times,
  211. (1986). The Foundation of Management.
  212. (1987). The Future of NHS General Management: Where Next?. King Edward Hospital Fund for London.
  213. (1982). The General Managers.
  214. (1986). The Griffiths Reorganization of the NHS: Fowlerism by Stealth? '
  215. (1986). The Griffiths Report: What Might it Mean to Nursing.
  216. (1992). The Health Divide.
  217. (1983). The Hospital and its Negotiated Order'.
  218. (1951). The Human Group. London: Routledge and Kegan Paul.
  219. (1988). The Impact of Research on Restructuring the British National Health Service',
  220. (1968). The Logic of Scientific Discovery.
  221. (1988). The Management of Clinicians in the National Health Service',
  222. (1990). The Management of Normality.
  223. (1975). The Management of Welfare.
  224. (1990). The Manager and the Wider World.
  225. (1985). The Meeting of the Steering Group of District General Managers
  226. (1983). The Mobilisation of Consent Versus the Management of Conflict: Decoding the Griffiths Report'.
  227. (1946). The National Health Service Act
  228. (1973). The National Health Service Reorganisation Act
  229. (1986). The National Health Service: Origins and Issues'. In
  230. (1983). The National Health Service: Who Rules?.
  231. (1973). The Nature of Managerial Work.
  232. (1990). The NHS Under New Management.
  233. (1984). The NHS verdict on HC(4)13'
  234. (1984). The NHS Verdict on HC(84)13'.
  235. (1986). The Nursing Management Function After Griffiths in the North-West Thames Region. London
  236. (1976). The Organization of Health Care:
  237. (1980). The Political Economy of Health,
  238. (1976). The Politics of Consumer Representation: A Study of Community Health Councils. London: Centre for Studies in Social Policy.
  239. (1984). The Politics of Ideology Versus the Reality of Politics: The Case of
  240. (1983). The Politics of Management in Health Care: A British Perspective'.
  241. (1973). The Politics of Organizational Decision-making.
  242. (1964). The Professionalization of Everyone? '.
  243. (1977). The Professions in the Class Structure'. In
  244. (1973). The Prolaterization of the Professional. Professionalization and Social Change'. Sociological Review,
  245. (1973). The Protection of Human Subjects: a Re-examination of the Professional Code of Ethics'.
  246. (1988). The Quality and Methods of Management Research'.
  247. (1970). The Reality of Organizations.
  248. (1988). The Reluctant Managers: Clinicians and Budgets in the NHS',
  249. (1977). The Reorganized NHS. Printed in England by White Crescent Press,
  250. (1970). The Research Act in Sociology.
  251. (1989). The Research Act: A Theoretical Introduction to Sociological Methods.
  252. (1977). The Rise of Professionalism: a sociological analysis.
  253. (1976). The Role of Medicine. Nuffield Provincial Hospitals Trust.
  254. (1938). The Rules of Sociological Method.
  255. (1988). The Sociology of Health and Healing. Unwin Hyman.
  256. (1982). The State and the Professions: Peculiarities of the British'. In
  257. (1980). The Strategy of Equality. London: Allen and Unwin.
  258. (1970). The Structure of Scientific Revolutions.
  259. (1973). The Struggle to Reform the Royal College of Physicians 1767-1771. A Sociological Analysis'.
  260. (1962). The Two Faces of Power',
  261. (1936). The Unanticipated Consequences of Purposive Social Action'.
  262. (1960). Uncertainty in Medical Prognosis Clinical and Functional'.
  263. (1988). Understanding Change in the NHS'.
  264. (1976). Understanding Organizations.
  265. (1966). Unobtrusive Measures. Rand McNally.
  266. (1990). What is Happening to Middle Management? '.
  267. (1970). What is Sociology?
  268. (1992). What's Wrong with Ethnography?
  269. (1981). Whatever Happened to the Case Study? '.
  270. (1985). When a New Manager Takes Charge'.
  271. (1984). Who Makes the Decisions in the NHS? '.
  272. (1976). Whose Stranger Am I? or Patients Really are People'. In
  273. (1984). Will 85 Percent Principle Work? '. Health and Social Service Journal,
  274. (1980). Work, Ideology and Science: The Case of Medicine'.

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.