Introduction

Significant investments in time, resources and energy (both physical and emotional) are being made in organisational change programmes across the world. However, little is known about what implementing change means to people responsible for leading the translation of change policies into practice. The purpose of this book is threefold: first, to understand better, through their narratives, what it means to a group of managers to lead and implement change; second, to appreciate what they say they need to support them in that process; and third, to demonstrate an approach to meeting those needs by viewing them in the context of a moral philosophical framework. The health sector is the primary case study for the study. The ‘modernising’ narrative introduced into the sector involved economic notions of efficiency and effectiveness, social elements in the transfer of care in hospital wards to care in the community, organisational factors in the increased level of multi-agency working and performance aspects with an emphasis on targets, ratings and standards. The narratives that run this book convey a sample of managers’ social reality over a period of 12 months. Raw accounts of how they handle situations where personal integrity, patient needs, government policy and public interests are at odds with each other form the core of the book.