Implementing changes to hospital services: factors influencing the process and 'results' of reconfiguration

Objectives: Acute hospital reconfiguration is often presented as a problem to be solved by calculations of optimal design, a rational process amenable to influence by open and responsive consultation. We aimed to analyse factors in the process and 'results' of hospital reconfiguration in three case study sites in the English NHS.

Methods: In-depth semi-structured interviews were conducted with internal and external stakeholders at each site. Analysis within each case was complemented by cross-case analysis focusing on the relationships between the features of the origins and process of reconfiguration and progress in the implementation of plans.

Findings: We identified a number of inter-related factors operating in the process of implementation which influenced the 'results': the drivers for change, the reconfiguration, its content (particularly the extent to which services are withdrawn or made less accessible), the influence of stakeholders, such as local politicians, financial pressures, and the role of the management team.

Conclusions: We argue that the differences in reconfiguration implementation between the three cases reflected the nature of the proposed changes and local politics, rather than the strength of the 'evidence' for change. National policy has tended to over-emphasise the importance of consultation using 'evidence' and underplays these influencing factors.