This analysis of the processes of strategic change is based on a four-year study of the UK's largest organization since general management replaced management by committee - the National Health Service. The findings are relevant to managers in all large organizations, whether private or public, and provide an agenda for management action. Amongst the more important are: that quality and coherence of policy is crucial to sustaining proposals for change; that team management is more effective than macho management; the crisis as a daily occurrence is the greatest enemy of change; that the lack of a single organizational culture is not a disadvantage, as it often facilitates flexibility; that the better the relationship between managers and professionals, the more successfully change can be achieved; that achievement of change depends to a considerable extent on good networks with local authorities and voluntary organizations; that managers with simple, clear priorities and persistence in pursuing objectives are most likely to achieve successful change; that local circumstances can produce totally different management action and results in furthering policy. Generic theories on the processes of strategic change are applied extensively and, in particular, the authors present their model of receptive and non-receptive contexts for change and its connection with the rate and pace of change. The case material examines: different kinds of strategic change; successful and less successful change processes; the interwoven role of people, policies, organizational cultures and relationships; environmental processes for change; and the political economy of change.