ABSTRACT
This chapter compares certain elements of the conduct of business in the NHS and in US health care. In many respects it has been the most difficult part of the book to write. Much of it is necessarily subjective and almost anecdotal in nature. An individual's exposure to different systems of management is necessarily limited - in the author's case to an NHS career for the most part spent in Wales (which has a distinctive organizational structure) and experience in the USA drawn from only one company. Certain differences in management style and culture are subtle and the danger is that in attempting to draw these out, one slips into characterization and generalities. However, this is too important an area to pass over as reform of the management process, perhaps more than any other single element described in this book, will determine the ability of the NHS (outside funding issues) to deliver quality services to the nation. Much of what has been observed is thought to be generally applicable.
