chapter  19
12 Pages

Dense Networks and Managed Dialogue: The Impact on the Patient Environment

ByRACHEL MACDONALD

The United Kingdom’s National Health Service (NHS) provides an interesting test bed for comparative managerial research. Despite being national, it is far from homogenous; standards of service vary widely. For nearly 20 years delivery of care has been managed at local level by semiautonomous units known as ‘trusts’ that deliver a range of hospital services. In the last 10 years political responsibility for services in Wales, Scotland and Northern Ireland has been devolved, with the services becoming more centrally managed by each province. The English NHS has seen the fi nancial autonomy of trusts increase even though the dominant discourse has been one of nationally managed standards with a number of mandated change initiatives.