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

• DOI: 10.1002/hpm.2469
• Publication Date: 2017-10-26T09:18:39Z
• Authors: E. Droog; C. Foley; O. Healy; C. Buckley; M. Boyce; S. McHugh; J.P. Browne
• Keywords: Control reconfiguration; Centralisation; Argument (complex analysis); Technocracy; Experiential Knowledge

Summary Background There is an increasing tendency to reconfigure acute hospital care towards a more centralised and specialised model, particularly for complex conditions. Although centralisation presented as “evidence‐based”, the relevant studies are often challenged by groups which hold perspectives values beyond those implicit in literature. This study investigated stakeholder on rationale reconfiguration of urgent emergency Ireland. Specifically, it considered hypothesis that individuals from different would endorse positions relation motivation for, goals of, reconfiguration. Methods Documentary analysis policy documents was used identify official justifications change. Semi‐structured interviews with 175 purposively sampled stakeholders explored their Results While there some within‐group variation, internal external generally vocalised lines argument. Clinicians management group proposed arguments favour based efficiency safety claims. External stakeholders, including campaigners local political representatives expressed focused access care. A “voter” argument, role politicians determining outcome planning, mentioned both critical fashion. Conclusion Our adds emerging literature interaction between technocratic approach health system planning advocated clinicians service managers, experiential “non‐expert” claims public patients.