This book uses the case of the National Health Service to examine the management of ambiguity and change. Studies of the implementation of the Griffiths Report have identified a number of unintended consequences, but it is argued that they have not adequately theorised these outcomes in the policy implementation process. It is suggested that the process-sociological approach of Elias, and in particular his game models, enable us to better understand the complex interweaving of planned and unplanned processes which is involved in the management of change.