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The central focus of the article is managing change in the National Health Service (NHS). In particular, it uses the implementation of general management (see the Griffiths Report, 1983) to explore the value of the process-sociological approach for understanding a number of unintended outcomes associated with this change. Elias is not a sociologist associated with the study of the NHS, or indeed the management of change, yet it is argued his approach has much to offer in exploring change in complex organizations such as the NHS. The article is organized as three sections. First, the central elements of a figurational approach are discussed and used to explore existing studies of change in the NHS. Second, the article applies a figurational approach to the study of the implementation of general management. Here the value of Elias's game models is explored in some detail. Finally, Elias's contribution to the study of complex social change is critically assessed.


Journal article



Publication Date





515 - 536


Health services; organizational change