Although there are renewed initiatives in HTA in Australia, there is a risk that such investments will not be productive unless policy makers also examine the decision-making contexts within which HTA can successfully be implemented. The results of this survey show that this is especially true at the local level and that any HTA initiative should be accompanied by efforts to improve decision-making processes.

How organizations communicate with shareholders during times of great uncertainty, such as during transformational change, is a relatively neglected area within the change management literature. We use the concept of “change conversation” and speech act theory to analyze GE's letters to shareholders 1980‐1999. We found five consistent change conversations through which GE's management sought to reassure shareholders and reduce their uncertainty around the expected outcomes of GE's transformational changes: warnings; actions; explanations; achievements, and predictions. These were underpinned by three types of speech acts: assertives, expressives, and commissives. We suggest that internally and externally oriented change conversations differ, the former being best characterized as operational change conversations and the latter as supportive change conversations. We suggest that successful change managers engage in both types of change conversations.

Health outcomes initiatives in NSW have concentrated on the development of indicators to monitor services and their effect on health, and on the use of indicator data to improve the quality and outcomes of health services.

Since the burgeoning of the 'health outcomes' movement there has been an ever-increasing body of literature on health outcomes policy debates, directions, frameworks and tools for implementing health outcome-directed initiatives. There is a significant gap in the literature, however, in regard to translating a comprehensive health outcomes policy into practice at a local level. This paper addresses that gap. It describes the local implementation of a comprehensive health outcomes approach which works across the continuum of care. It identifies those organisation-wide structures and processes that support successful progress, thereby providing a useful guide to other organisations wishing to institutionalise the health outcomes approach.