Framing in policy processes: A case study from hospital planning in the National Health Service in England

Abstract

This paper reports from an ethnographic study of hospital planning in England undertaken between 2006 and 2009. We explored how a policy to centralise hospital services was espoused in national policy documents, how this shifted over time and how it was translated in practice. We found that policy texts defined hospital planning as a clinical issue and framed decisions to close hospitals or hospital departments as based on the evidence and necessary to ensure safety. We interpreted this framing as a rhetorical strategy for implementing organisational change in the context of community resistance to service closure and a concomitant policy emphasising the importance of public and patient involvement in planning. Although the persuasive power of the framing was limited, a more insidious form of power was identified in the way the framing disguised the political nature of the issue by defining it as a clinical problem. We conclude by discussing how the clinical rationale constrains public participation in decisions about the delivery and organisation of healthcare and restricts the extent to which alternative courses of action can be considered.

(Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare

“…12 Evidence-based standards are, on occasion, not founded on the “best” evidence but on opinion and consensus, which is seen to be weaker in quality. 13 Meta-reviews have shown, for example, that only in 50% of cases do clinicians follow clinical practice guidelines endorsed by national and professional medical organizations. In an ethnographic study in UK primary care, it was found that general practitioner (GP) clinicians only rarely consult clinical guidelines directly when making clinical decisions.…”

‘Holding the line’: a qualitative study of the role of evidence in early phase decision-making in the reconfiguration of stroke services in London

“…We suggest that the discursive mobilisation of clinical research evidence to frame hospital reconfigurations in recent years is an increasingly important technique aimed at depoliticising contentious choices [4, 25], aligning with macro-level assertions around the importance of evidence-based medicine (EBM) to influence health policy decisions more generally [26–29] and that this was central to the London stroke service reconfiguration. Change framed as ‘evidence based’ has a rhetorical power that discourages dissent [25, 27] and a legitimating power that enables its proponents to establish jurisdiction over specific fields of practice [26, 30, 31].…”

“…Change framed as ‘evidence based’ has a rhetorical power that discourages dissent [25, 27] and a legitimating power that enables its proponents to establish jurisdiction over specific fields of practice [26, 30, 31]. This study draws on this existing literature and applies it to study how senior decision-makers mobilised the discourse of EBM as a technique of power [32, 33] so as to ‘hold the line’ [15] and provide ‘system leadership’ [8] in the critical early stages of the London stroke reconfiguration.…”

Engagement of patients and the public in NHS sustainability and transformation: An ethnographic study

“…The catch-phrase reinforced and replicated the discourse and messages of the Five Year Forward View; paradoxically, fewer hospital beds was presented as a solution to the problem frame ( Jones and Exworthy, 2015) of 'relentless demand'. A leading figure from a national think-tank then gave a presentation and advocated:…”

“…Hospital 'closure' was discursively represented as 'reconfiguration' (Jones and Exworthy, 2015) by communications staff and others but in one meeting an involvee expressed their need for and expectation of 'honest' communication:…”