title: Factors that influence the way communities respond to proposals for major changes to local emergency services: a qualitative study.
abstract: OBJECTIVE
  According to policy commentators, decisions about how best to organise care involve trade-offs between factors relating to care quality, workforce, cost, and patient access. In England, proposed changes such as Emergency Department closures often face public opposition. This study examined the way communities respond to plans aimed at reorganising emergency services, including the trade-offs inherent in such decisions.
  
  
  METHODS
  Cross-sectional study involving in-depth interviews. Participants selected their priorities for emergency care, including aspects they might be prepared to have 'less' of (e.g. rapid access) if it meant having 'more' of another (e.g. consultant-delivered care). A thematic analysis was carried out, combining inductive and deductive approaches, drawing on theories about risk perception.
  
  
  METHODS
  Two urban areas of England; one where changes to emergency services were under consideration ('Greenville'), and one where they were not ('Hilltown').
  
  
  METHODS
  28 participants in total. Greenville interviewees included more common emergency service users - parents of young children (n=5) and older people (n=6) - plus patient representatives and individuals campaigning against service closures (n=9). Hilltown interviewees (n=8) received outpatient care for Chronic Obstructive Pulmonary Disease, an important cause of emergency admission.
  
  
  RESULTS
  Most participants, in both areas, were not willing to accommodate the trade-offs involved in consolidating emergency services, principally because of the belief that timely access is associated with better outcomes. Participants did not consider the proposed improvements as gains worth having; interviewees believed care quality would be adversely impact, partly because increased patient numbers would place staff under greater pressure and result in longer waiting times.
  
  
  CONCLUSIONS
  Visible clinical leadership and detailed explanation of the case for change were insufficient to overcome opposition to the reconfiguration in Greenville, challenging the assumption that communities can be persuaded by evidence. Commissioners should make explicit credible plans to accommodate changes in patient flows, as well as clarifying the roles played by key staff groups.
authors: Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
authors: Helen
authors: H
authors: Barratt
authors: Intensive Care National Audit and Research Centre, 24 High Holborn, London WC1V 6AZ, United Kingdom.
authors: David A
authors: DA
authors: Harrison
authors: Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
authors: Naomi J
authors: NJ
authors: Fulop
authors: Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
authors: Rosalind
authors: R
authors: Raine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000600:supply & distribution*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012111:Residence Characteristics