Patterns of Strategic Change in Health Care: District Health Authorities Respond to AIDS*

Abstract

SUMMARYThe literature on strategic change is based mostly on research in the private sector. This paper suggests that change in public sector organizations is equally worthy of study and can offer novel insights. Findings from research into the development of services for HIV/AIDS in NHS health districts are used to illustrate six generic themes in strategic change processes. The first theme concerns the role of context in potentiating change, and in promoting a diverse response in different localities despite unifying government guidelines. A second theme introduces the initiators of change, the ‘product champions’, a less homogeneous group than is sometimes suggested. Although personal status, energy and pro‐activity were shared characteristics, individuals differed in style and methods used to attain goals. Theme three highlights social movements as mediators of change. Consumerism has affected both private and public sector industry, but for HIV/AIDS the process has been particularly visible. The mobilising role of crisis comes next. A three phase model is suggested, linking ‘crisis‐as‐threat’ and ‘crisis‐as‐opportunity’ theories. A fifth theme concerns changes in organizational culture provoked by HIV/AIDS, and the role played by symbolism ‐ often unpredictable and not easily manipulated by management. The last theme is organizational learning; how learning about HIV/AIDS diffused through the districts, and how well learning generalizes to other issues. In conclusion, it is argued that the study of processes of change in a public sector organization can contribute to general models of strategic change and help to develop organizational theory.