This thesis investigates strategic change in a district health authority between 1985 and 1993 when the district implemented a series of top-down initiatives concerned with fundamentally transforming the service, based on the introduction of general management, the implementation of a quality management initiative and the subsequent internal marker reforms. The particular initiative which forms the central focus of this thesis was a Department of Health TQM demonstration site which was established in the district in 1989 and continued till 1993. The research started from a concern to reveal the process of managing strategic change in the district through the implementation of TQM. The research, comprising focused interviews, was guided by a contextualist approach, and conducted with senior managers, members of the quality team and training staff who were directly involved with the demonstration site. The case study data was analyzed against theories derived from the literature about strategic change in the public services and particularly the NHS. The analysis of the case study data revealed that in spite of initial enthusiasm on the part of a small core of managers and staff, the TQM initiative quickly experienced setbacks, resulting from its rejection by clinicians, internal disagreements about priorities, failure to diffuse quality management techniques and the loss of key personnel. These difficulties were intensified by the impact of the Working for Patients reforms on the district, resulting in the growing demands of a parallel and powerfully driven change agenda which led to the break up of the district into separate units in preparation for trust status, with a reduction in the activities of the TQM demonstration site. The demonstration site finally closed in 1993 when funding came to an end, although there had been diminishing interest on the part of the Department of Health from 1990.