Perspectives on the underlying drivers of urgent and emergency care reconfiguration in Ireland

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dc.contributor.author Droog, Elsa
dc.contributor.author Foley, Conor
dc.contributor.author Healy, Orla
dc.contributor.author Buckley, C.
dc.contributor.author Boyce, Maria B.
dc.contributor.author McHugh, Sheena M.
dc.contributor.author Browne, John P.
dc.date.accessioned 2018-07-30T12:30:33Z
dc.date.available 2018-07-30T12:30:33Z
dc.date.issued 2018
dc.identifier.citation Droog, E., Foley, C., Healy, O., Buckley, C., Boyce, M. B., McHugh, S. and Browne, J. P. (2018) 'Perspectives on the underlying drivers of urgent and emergency care reconfiguration in Ireland', International Journal of Health Planning and Management, 33(2), pp. 364-379. doi: 10.1002/hpm.2469 en
dc.identifier.volume 33
dc.identifier.issued 2
dc.identifier.startpage 364
dc.identifier.endpage 379
dc.identifier.issn 0749-6753
dc.identifier.uri http://hdl.handle.net/10468/6536
dc.identifier.doi 10.1002/hpm.2469
dc.description.abstract Background: There is an increasing tendency to reconfigure acute hospital care towards a more centralised and specialised model, particularly for complex care conditions. Although centralisation is presented as evidence-based, the relevant studies are often challenged by groups which hold perspectives and values beyond those implicit in the literature. This study investigated stakeholder perspectives on the rationale for the reconfiguration of urgent and emergency care in Ireland. Specifically, it considered the hypothesis that individuals from different stakeholder groups would endorse different positions in relation to the motivation for, and goals of, reconfiguration. Methods: Documentary analysis of policy documents was used to identify official justifications for change. Semi-structured interviews with 175 purposively sampled stakeholders explored their perspectives on the rationale for reconfiguration. ResultsWhile there was some within-group variation, internal and external stakeholders generally vocalised different lines of argument. Clinicians and management in the internal stakeholder group proposed arguments in favour of reconfiguration based on efficiency and safety claims. External stakeholders, including hospital campaigners and local political representatives expressed arguments that focused on access to care. A voter argument, focused on the role of local politicians in determining the outcome of reconfiguration planning, was mentioned by both internal and external stakeholders, often in a critical fashion. Conclusion: Our study adds to an emerging literature on the interaction between a technocratic approach to health system planning advocated by clinicians and health service managers, and the experiential non-expert claims of the public and patients. en
dc.description.sponsorship Health Research Board (CARG/2012/28) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher John Wiley & Sons Inc. en
dc.relation.uri https://onlinelibrary.wiley.com/doi/abs/10.1002/hpm.2469
dc.rights © 2017, the Authors. Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. en
dc.rights.uri https://creativecommons.org/licenses/by/4.0/
dc.subject Evidence en
dc.subject Finance en
dc.subject Politics en
dc.subject Stakeholder perspectives of change en
dc.subject Urgent and emergency care reconfiguration en
dc.title Perspectives on the underlying drivers of urgent and emergency care reconfiguration in Ireland en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Elsa Droog, Epidemiology & Public Health, University College Cork, Cork, Ireland. +353-21-490-3000 Email:e.droog@ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.contributor.funder Health Research Board
dc.description.status Peer reviewed en
dc.identifier.journaltitle International Journal of Health Planning and Management en
dc.internal.IRISemailaddress e.droog@ucc.ie en
dc.internal.IRISemailaddress j.browne@ucc.ie en


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© 2017, the Authors. Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Except where otherwise noted, this item's license is described as © 2017, the Authors. Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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