Introduction

This book’s central object is to address some of the more theoretical issues involved in the analysis of what might be called ‘managed social change’, that is to say, change which has been deliberately initiated with the specific objective of achieving some formally stated policy goal. There are many theories that can assist in understanding issues surrounding ‘managed social change’ (many are helpfully reviewed in Pettigrew et al.’s book Shaping Strategic Change, 1992). It is suggested in this book that the process-sociological approach developed by Norbert Elias, and in particular Elias’s game models, may be another useful approach for those studying health services management and health care organization and, in particular, that it can shed light on problems of managing change and, more especially, the relationship between planned and unplanned processes of change. The book grows out of earlier research (Dopson, 1994) on the introduction, following the publication of the Griffiths Report (DHSS, 1983), of general management into the National Health Service (NHS).