The Influence of Middle Managers in the Business Planning Process: A Case Study in the UK NHS

The paper takes a processual approach (Mintzberg and Waters, 1985; Pettigrew, Ferlie and McKee, 1992) in conjunction with a typology of middle‐management influence upon strategic change (Floyd and Wooldridge, 1992) to investigate the role of middle managers in business planning in the National Health Service (NHS). Over time, as the business planning process becomes increasingly one which adopts a top‐down approach, the main influence middle managers have is upon the implementation of deliberate strategic change. Middle managers modify the implementation of deliberate strategy by contesting the performance indicators that form the basis of the business planning framework. In particular they draw upon features of inner and outer context of the organization to question the legitimacy of business planning. However, the findings also show, albeit to a limited extent, that middle managers are purveyors as well as recipients of change. That middle managers can have upward influence has important implications for policy‐makers since potentially, middle managers can enjoy an enhanced role and add value to organizations, in this case to patient care. Therefore recent attacks upon their numbers and role may be misplaced. In addition a high degree of central intervention in the NHS generally may be inappropriate, since it militates against an enhanced role for middle managers.