This article illustrates how distributed change agency can implement complex organizational changes in the absence of formal management plans, roles, and structures. Distributed change agency typically involves small teams and senior groups. In this qualitative study of service improvements in the treatment of prostate cancer at an acute hospital, Grange, change roles were distributed more widely, with responsibilities `migrating' among a large informal cast supporting four central characters. This distribution appears to have been triggered by the change goals and substance, and by the network organization through which services were delivered. Cross-case comparisons with other hospitals, Henley and Norwood, suggest that a combination of factors contributed to the development of a distributed approach. Analytical generalization invites speculation concerning the transferability of this model, with `nobody in charge', to other settings. One policy implication concerns the provision of development in change agency competencies to staff other than those in senior positions.

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Managed networks are increasingly common in the British National Health Service (NHS) as a means of streamlining and standardizing patient care across organizational and professional boundaries. However, there has been limited research regarding whether this technique is the most appropriate management style for delivery of health services. This article draws upon the authors' research on managed clinical networks for cancer in the UK-a model that set out to guide and develop knowledge flows across cancer service providers. It examines how the initial purpose of these networks was distorted by the broader function of New Labour's 'modernization agenda', which has ultimately focused on organizational restructuring and adhering to government targets. Our analysis, which develops Lozeau, Langley and Denis's model of the corruption of managerial techniques, suggests that the initial knowledge-sharing purpose of networks underwent top-down 'distortion' by the demands of central government. This resulted in superficial bottom-up adoption of the networks model and limited impact upon organizational processes.

This paper uses empirical data from five case studies of managed clinical networks to theorise the nature of power relations in the development and implementation of network reform in cancer services. Also, there is limited understanding of the nature of power relations in network relationships, particularly in relation to the public sector.

There is only limited research on the emergent remit, structure or strategy of public sector Boards in the UK, and very limited research on the role of Boards in health care networks: the paper provides some illumination on this limited area of study.