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Is the end in sight? A study of how and why services are decommissioned in the English National Health Service
Sociology of Health & Illness ( IF 2.957 ) Pub Date : 2021-02-26 , DOI: 10.1111/1467-9566.13234
Iestyn Williams 1 , Jenny Harlock 2 , Glenn Robert 3 , John Kimberly 4 , Russell Mannion 1
Affiliation  

The decommissioning of a health‐care service is invariably a highly complex and contentious process which faces many implementation challenges. There has been little specific theorisation of this phenomena, although insights can be transferred from wider literatures on policy implementation and change processes. In this paper, we present findings from empirical case studies of three decommissioning processes initiated in the English National Health Service. We apply Levine's (1979, Public Administration Review, 39(2), 179–183) typology of decommissioning drivers and insights from the empirical literature on pluralistic health‐care contexts, complex change processes and institutional constraints. Data include interviews, non‐participant observation and documents analysis. Alongside familiar patterns of pluralism and political partisanship, our results suggest the important role played by institutional factors in determining the outcome of decommissioning processes and in particular the prior requirement of political vulnerability for services to be successfully closed. Factors linked to the extent of such vulnerability include the scale of the proposed changes and extent to which they are supported at the macrolevel.

中文翻译:

末日在望吗?一项关于如何以及为何在英国国民健康服务中停用服务的研究

医疗保健服务的退役总是一个高度复杂和有争议的过程,面临着许多实施挑战。尽管可以从关于政策实施和变革过程的更广泛的文献中获得见解,但对这种现象几乎没有具体的理论化。在本文中,我们展示了对英国国家卫生服务机构发起的三个退役过程的实证案例研究的结果。我们应用了 Levine (1979, Public Administration Review, 39(2), 179–183) 退役驱动因素的类型学和关于多元化医疗保健背景、复杂变化过程和制度约束的实证文献的见解。数据包括访谈、非参与者观察和文件分析。除了熟悉的多元化和政治党派模式之外,我们的结果表明,制度因素在决定退役过程的结果方面发挥了重要作用,尤其是成功关闭服务的政治脆弱性的先决要求。与此类脆弱性程度相关的因素包括拟议变化的规模以及它们在宏观层面得到支持的程度。
更新日期:2021-04-24
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