In late 1983 instructions were issued to abolish the district level of management in the Scottish National Health Service. Following on from the recommendations of the Griffiths Report, unit-based management was introduced. Unit general managers were appointed who, in turn, reported to general managers at board level.

These changes were adopted at the hospital, which, following the abolition of South Lothian District of Lothian Health Board, became the Royal Infirmary of Edinburgh and Associated Hospitals Unit. Staff and committee titles and functions were gradually transformed during the 1980s.

The unit structure remained in place until the formation of the Royal Infirmary of Edinburgh NHS Trust in 1994. Over this period the other hospitals included in the Unit at various times were Simpson Memorial Maternity Pavilion, Elsie Inglis Memorial Maternity Hospital, Chalmers Hospital, Edinburgh Dental Hospital, City Hospital, Princess Margaret Rose Orthopaedic Hospital and Princess Alexandra Eye Pavilion.