title: Implementing changes to hospital services: factors influencing the process and 'results' of reconfiguration.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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the 'results': the drivers for change, the reconfiguration, its content (particularly the extent to which services are withdrawn or made less accessible), the influence of stakeholders, such as local politicians, financial pressures, and the role of the management team.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.
authors: King's College London, Division of Health and Social Care Research, School of Medicine, London, United Kingdom. naomi.fulop@kcl.ac.uk
authors: Naomi
authors: N
authors: Fulop
authors: Rhiannon
authors: R
authors: Walters
authors: Perri
authors: Peter
authors: P
authors: Spurgeon
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration; D006739:Hospital Administration / Q000379:methods; D006752:Hospital Planning / Q000379:methods / Q000458:organization & administration; D006780:Hospitals, Rural / Q000458:organization & administration; D006786:Hospitals, Urban / Q000458:organization & administration; D009936:Organizational Innovation; D016730:Program Development; D013222:State Medicine / Q000458:organization & administration; D006113:United Kingdom