ABSTRACT
This chapter addresses major challenges in improving health care. It introduces intertwined themes, which constitute significant demands on current health care systems. The first theme focuses on how to effectively leverage organizational change through top-down, policy-driven mandate. As a lens through which to explore this theme, the chapter explores the issue of fairly commissioning health care. The second theme is also endemic. Whether a country is resource rich or resource poor, commissioning as a process addresses a fundamental problem in all health care systems, how to allocate limited resources. The chapter explores research on mandated top-down change as an approach to organizational change, focusing on the exemplar of restructuring. It examines whether mandated change in health care might be perceived as an effective means of leveraging change and even of inducing the 'jolt' necessary to precipitate an organizational transformation. The chapter utilizes the example of the restructuring of commissioning to facilitate a final discussion of government mandated 'top-down' change.
