In any complex system, information is collected, stored and acted on at many levels. If an organisation is going to be effective, these stocks of knowledge and flows of information have to be in the right place. In large organisations like the NHS, long-term strategic decision-making tends to be done at higher levels, where power tends to be more concentrated and widely disparate information can be collected and refined. Short-term tactical decision-making tends to be distributed to the periphery. Drawing the line between what is strategic and tactical in the right place is critically important and the more complex the periphery, the more of that decision making should be widely distributed.
In their article Gilles et al say that the NHS, ‘fails to understand general practice [which is] small, dispersed, and often engaged with …