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

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dc.contributor.authorDroog, Elsa
dc.contributor.authorFoley, Conor
dc.contributor.authorHealy, Orla
dc.contributor.authorBuckley, C.
dc.contributor.authorBoyce, Maria B.
dc.contributor.authorMcHugh, Sheena M.
dc.contributor.authorBrowne, John P.
dc.contributor.funderHealth Research Board
dc.date.accessioned2018-07-30T12:30:33Z
dc.date.available2018-07-30T12:30:33Z
dc.date.issued2018
dc.description.abstractBackground: 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.sponsorshipHealth Research Board (CARG/2012/28)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationDroog, 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.2469en
dc.identifier.doi10.1002/hpm.2469
dc.identifier.endpage379
dc.identifier.issn0749-6753
dc.identifier.issued2
dc.identifier.journaltitleInternational Journal of Health Planning and Managementen
dc.identifier.startpage364
dc.identifier.urihttps://hdl.handle.net/10468/6536
dc.identifier.volume33
dc.language.isoenen
dc.publisherJohn Wiley & Sons Inc.en
dc.relation.urihttps://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.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectEvidenceen
dc.subjectFinanceen
dc.subjectPoliticsen
dc.subjectStakeholder perspectives of changeen
dc.subjectUrgent and emergency care reconfigurationen
dc.titlePerspectives on the underlying drivers of urgent and emergency care reconfiguration in Irelanden
dc.typeArticle (peer-reviewed)en
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