This article explores the question of why change management was an issue in the NHS in the 1980s. It reports the results of a study which explored reasons for variability in the observed rate and pace of strategic service change in the NHS. The article introduces the metaphor of 'receptive' and 'non-receptive' contexts for change, as well as outlining eight 'signs and symptoms' of receptivity. It provides a logic and language which may enable a better understanding of the processes of change in the NHS.
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