Public Management in Uncertainty: a micro-political perspective of the health service in the United Kingdom

Abstract

An increasingly common characteristic of public sector organisations in Britain and elsewhere in Western Europe is a heightened sense of uncertainty. Assumptions that have been cherished for decades are being challenged, and for large public institutions, used to plotting their way into the future in much the same direction as they left the past, the strength of the challenge and the wide front over which it is taking place is causing increasing concern for both managers and politicians. In this paper we examine the uncertainty created within the National Health Service by an increasingly rapid shift from passive administration to more assertive management and from welfare values to market forces. We use the experience of a small group of District General Managers with whom we worked to try and better understand how managers have thought through these changes in practice. We go on to reflect on that experience and suggest a series of coping strategies for managing in uncertainty.