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At the time of publication, Andrew Pettigrew and colleagues’ book received wide acclaim as a balanced and rich contribution to the study of strategic change. Eighteen years since publication, it remains a relevant analysis of how new processes and environmental factors impact on health care, and how strategic change is dependent on locale, fiscal situation, structures, politics, and people. It can help illuminate current issues in the commissioning landscape in the English NHS outlined in the recent White Paper. 1 Pettigrew and colleagues highlight that much research on organizational change is ahistorical, aprocessual and acontextual. They advocate longitudinal and historical accounts of strategic change, with an emphasis upon action, as well as structure, and the competing versions of change held by various actors. Through a comparative case analysis of a limited number of in-depth cases, they examine the …