Finding the right balance of levers and incentives in reform packages for different services is problematic, as is the avoidance of potential conflicting objectives. In order to provide an understanding of how the reform processes interconnect, and so provide key lessons in the future development of the reform programme, this project will:

• explore empirically how complex policy initiatives are being operationalised (implemented) within a range of local health economies (contexts), including how these local implementations are intended to operate (process) and their observed effects (outcomes);
  
  
• identify the extent to which policy initiatives are proving effective in addressing specific local issues in a range of 'tracer' conditions/service areas, including an assessment of the impact on the interactions and dynamics within organizations as well as between them.