By Annabel Broome (auth.)

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It makes the case for full diagnosis, to include affected parts. For example: the efficiency of the supplies department affects the care given in the operating theatres; the personnel department affects the swift replacement of staff and therefore the continuity of service in the records department; the communication skills of the reception staff affect the way the patients view the hospital at first outpatient appointment. 45 Managing Change Surrounding (or boundary) services can also affect the delivery of the target organization or system.

These need to be operationally defined so that two different observers agree on 51 Managing Change what is to be changed and the means of achieving that change. Consider the objective 'to reduce the waiting list by 20 per cent' . Astute readers will notice problems with this. There is no time span and so two observers might have quite different understandings of what is a waiting list. One might take the view that it consists of all those people who have seen the consultant once and are waiting for treatment; another might view it as all those people who are still waiting for their first consultant appointment.

As a conductor, he encourages experiment; he wants to try new tunes! Not all those he's attracted to are performed or even finished. He sees his general manager role mainly as a change agent. Indeed, in the American book The Nurse as a Change Agent, by Lancaster and Lancaster, the nurse manager's main role is defined as a change agent. Creating a Climate of Change Successful organizations in the market place have to adapt continually to a swiftly moving economy. For them, the power to self-generate is often the key to survival and success, but to do this they need a strong culture of learning, taking risks, making mistakes, and learning from them.

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