Processes of change in bureaucratic environments
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This chapter discusses the forces that operate within bureaucratic health service environments and the impact upon individuals and groups within them. It also discusses some of the recent positive movements towards assisting innovation and change in these environments. Change can be likened to a fast-flowing river: it continues remorselessly and it is very easy to get caught up in its currents. Once you are within a context where change is happening all around you, it becomes very difficult to do anything other than work extremely hard to keep your head above water. This is the situation for many nurses when they take up their first position in health services. However, as we shall see, it is not a situation that is peculiar either to nursing or to relatively inexperienced people.