Modern Matrons are at the vanguard of both care delivery and the NHS reforms and have an important role in the modernisation of, and future delivery of healthcare. An important contextual feature of their role and a concept that has been widely embraced by the National Health Service, is that of decentralized decision making. Unlike clinical decision making which has been extensively studied, there is little in the healthcare literature regarding leadership and management decision making or the concept of decentralised decision making. In order to maximise the effectiveness of the Modern Matron role, it is important that we gain a thorough understanding of how they make leadership and management decisions, the reality of the term decentralized decision making for them and an insight into their abilities and needs in regards to this essential skill.