Health planning and the closure of a community hospital

Abstract

The overall purpose of the research reported in this article is two-fold: firstly, to describe the efforts of a regional health planning agency in the United States to reduce the size of acute care facilities in its planning area; and, secondly, to frame these events into a general theory of structural problems of state interventions in the American health care sector. Specifically, a case study is presented that documents--over time--the process of decision making, in seeking to close a community hospital against strong, and vocal, local interests. This analysis supports the view that, in the real world of health planning, power is exercised through a process of bargaining between health care providers and government, and between health care providers. Overall, the study illustrates the constraints upon the American health planning agencies to steer a relatively autonomous health care sector.

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

“…A growing international literature focuses on system wide health service reconfiguration, mergers and regional hospital service re-design in Europe [2–8] and North America [9–13]. These studies emphasise that reconfigurations are notoriously problematic and proposed solutions are frequently contested and bedevilled by conflict amongst different policy actors [1, 4, 12].…”

“…Reconfiguration is “ a deliberately induced change of some significance in the distribution of medical, surgical, diagnostic and ancillary specialities that are available in each hospital or other secondary or tertiary acute care unit in locality, region or healthcare administrative area ” [ 1 ]. A growing international literature focuses on system wide health service reconfiguration, mergers and regional hospital service re-design in Europe [ 2 – 8 ] and North America [ 9 – 13 ]. These studies emphasise that reconfigurations are notoriously problematic and proposed solutions are frequently contested and bedevilled by conflict amongst different policy actors [ 1 , 4 , 12 ].…”

A sociology of public responses to hospital change and closure

“…(Abelson , Barnett and Barnett , Fontana , Haas et al . , Kirouac‐Fram , Lepnurm and Lepnurm , Reda )…”

“…Perspectives not amenable to negotiation or management Engaged rejection of financial or clinical case for change Barnett 2003, Oborn 2008) Public being orchestrated/manipulated by other actors (especially hospital staff) (Abelson 2001, Dent 2003, Kirouac-Fram 2010 Distrust of and/or breakdown in relationship between public and authority (Abelson 2001, Brown 2003, Kirouac-Fram 2010, Oborn 2008, Thomson et al 2008 Emotional attachment to hospitals (sometimes linked to social cleavages) (Abelson 2001, Barnett and Barnett 2003, Fontana 1988, Haas et al 2001, Kirouac-Fram 2010, Lepnurm and Lepnurm 2001, Reda 1996 Functional fears about access to services or future viability of community (Gifford and Mullner 1988, Goyder 1999, James 1999, Kirouac-Fram 2010, Lindbom 2014 Symbolic role of hospitals in representing locality or wider health-care system (Brown 2003, Gifford and Mullner 1988, James 1999, Moon and Brown 2001 Concerns about legitimacy of process (Barnett and Barnett 2003, Daniels et al 2013, Joseph and Kearns 1996, Joseph et al 2009, Oborn 2008, Parkinson 2004 Different understandings of acceptable risk (Barratt et al 2015) elusive and in some ill-defined way problematicpublic" (Wynne 2015). This literature rejects the idea that a public can be weighed and measured through the individual opinions of the individuals within it (Chilvers and…”

Beyond NIMBYs and NOOMBYs: what can wind farm controversies teach us about public involvement in hospital closures?

“…Social scientific research can explore the role of generalised relationships of (mis)trust between publics and their health systems, as the context in which particular decisions take on specific meanings for local populations. Multiple studies note the repeated introduction of proposals to close a facility over a number of years [ 13 , 51 , 54 , 55 ], and yet there is little attempt to explore the impact of this longitudinally within a local population. Attending to process, rather than outcome, might also yield more optimistic findings.…”