INTRODUCTIONThis article focuses on how the National Health Service, as a major public service organization, operating in a dynamic environment and utilizing complex processes of human interaction to deliver health care, creates and manages legitimacy. During the late 1990s the NHS embodied a particular series of changes which demanded novel responses from managers, clinicians and service users in relation to governance and professional standards. Most challenging of all are the attempts being launched to exert influence over the organization and management of clinical services, through clinical governance systems which create 'shared forums' for quality improvement (Scottish Office/Department of Health 1998). The emphasis here is to draw upon theoretical constructs of legitimacy and discourse as organizing schema for making sense of such change processes. The role of doctors who assume managerial duties will be examined as a prominent feature of the reform programme.The problem of sourcing, building and maintaining legitimacy in the NHS is viewed through the new medical managers' representations of their role in the devolved management structures of the NHS in the 1990s. The new medical managers are clinicians who take on a management position within NHS trust organizations. As argued elsewhere the NHS has been for the first fifty years of its life, essentially a federation of professional tribes, each with their own social practices and inclination to attach different subjective meanings to health care processes (Hunter 1994). The new medical managers are seen as occupying a position between the organization that is the NHS trust and the profession-based institutions. Their part in creating an integrated corporate form of legitimacy is of some importance for the NHS in the next century. The developments under examination may signal a radical departure from earlier organizational practices, which relied on finding accommodations between professional tribes, whose insistence on high levels of autonomy was normally tolerated. THE NHS AND LEGITIMACYThe NHS has traditionally relied on strong sources of societal legitimacy, derived from the extent to which its patients, employees and the public at large were persuaded of the integrity of familiar values and processes. In part, legitimacy was derived from the role played by professionals. Hogg (1999 p. 7) writes that 'doctors are expected to be experts, adhere to high ethical standards and not make mistakes'. However, the raw evidence contained in electoral surveys, also consistently demonstrates public support for the National Health Service as an organization. Nigel Lawson, a prominent politician of the right during the 1980s, described the NHS as the nearest thing the British had to a national religion (Timmins 1996, p. 453). In short, the NHS has seemed to deliver health care in the 'right way' and has, more than any other organization, fulfilled the principles of the postwar settlement struck by Labour in the late 1940s. It has been an organization, which has bee...

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TX 75083-3836, U.S.A., fax 01-972-952-9435. AbstractInterviews have been conducted with decision-makers in most of the operating companies active in the UK North Sea. The data generated by these interviews defines industry current capability in decision analysis. The extent to which each company uses the techniques which comprise current capability defines a rank list representing relative level of sophistication in decision analysis. This rank list is then correlated with other rank lists based on common measures of business performance to establish the value, to companies, of adopting best (or, at least, better) practice in decision analysis. The strong positive correlation found indicates a considerable incentive for companies to upgrade their decision analysis capability.

TX 75083-3836, U.S.A., fax 01-972-952-9435. AbstractThis paper reports on research examining established decisionmaking in the Upstream Oil and Gas Industry. Two important aspects of the strategic decision making process are highlighted. The main emphasis is on exploring the often neglected intuitive (or non-analytical aspects) of the process although the analytical aspects will also be highlighted and both aspects will be considered in combination. As a means of comparison across companies, companies will then be grouped into different typologies based on the different emphases they place on the intuitive/ analytical aspects. Finally, a model of strategic decision making will be presented which integrates various aspects of the decision making process a . This research is based on analysing the information derived from fifty three face-toface interviews with individuals working in the UKCS and in Australia who had knowledge of the strategic decision-making process. Eleven operators and one contractor were involved in the study. Initially, open-ended interviews were conducted and this was later followed by semi-structured in-depth interviews. A grounded theory approach was used to analyse the results. Ultimately, it is hoped that the research will be of interest to companies who wish to increase the transparency and their understanding of the strategic decision making process. It will also help companies both to recognise and accrue the valuable contribution of both intuition and analysis in strategic decision making. It is also suggested that although the intuitive aspects may be less visible and widely acknowledged due to their tacitness, difficulty in being codified and communicated, under certain 'unique' circumstances as evidenced by 'intuitive decisions' they may become more visible, codified and more easily articulated and shared.

This paper develops an explanation of how large business organisations may achieve advantages of size by virtue of decision-making procedures. The argument is inspired by Knight's (Risk, Uncertainty and Profit, NewYork: Houghton Mifflin, 1921) model of internal business organisation, together with his explanation of profits pertaining to large business organisations by being connected with situations that he characterises as uncertain rather than risky. Capturing the decision-making advantages is fairly straightforward in Knight's explanation. Decision making is internalised to individuals who cope with uncertain situations— beyond the range of normal experience— in a manner consistent with managerial/entrepreneurial vision. Recent organisation theory has drawn attention to the use of groups as an integral part of decision making within large business organisations and this has important implications for economics. This paper highlights the role of groups in achieving Knightian advantages. The argument loosens the identification of organisation with a managerial/entrepreneurial vision, adding different levels and types of deliberate and automatic selection, the alignment of which is likely to be problematic.Decision Making, Uncertainty, Large Business Organisations, Frank Knight, Capabilities, Shared Mental Models,