Droog E, Foley C, Healy O, Buckley C, Boyce M, McHugh S, Browne J P
Department of Epidemiology and Public Health, Faculty of Medicine and Health, University College Cork, Cork, Ireland.
Department of Public Health, HSE South Region, St. Finbarr's Hospital, Cork, Ireland.
Int J Health Plann Manage. 2018 Apr;33(2):364-379. doi: 10.1002/hpm.2469. Epub 2017 Oct 26.
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.
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.
While 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.
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.
将急性医院护理重新配置为更集中、更专业化模式的趋势日益增强，尤其是针对复杂护理情况。尽管集中化被视为“基于证据”，但相关研究常常受到持有文献中未隐含观点和价值观的群体的质疑。本研究调查了利益相关者对爱尔兰紧急和急诊护理重新配置理由的看法。具体而言，它考虑了这样一种假设，即来自不同利益相关者群体的个人在重新配置的动机和目标方面会支持不同的立场。
通过对政策文件的文献分析来确定变革的官方理由。对175名经过有目的抽样的利益相关者进行半结构化访谈，探讨他们对重新配置理由的看法。
虽然群体内部存在一些差异，但内部和外部利益相关者普遍表达了不同的论点。内部利益相关者群体中的临床医生和管理人员基于效率和安全主张提出了支持重新配置的论点。外部利益相关者，包括医院活动家及当地政治代表，表达了侧重于医疗服务可及性的论点。内部和外部利益相关者都提到了一个“选民”论点，该论点关注当地政治家在决定重新配置规划结果中的作用，且通常是以批评的方式提及。
我们的研究为关于临床医生和卫生服务管理人员所倡导的技术官僚式卫生系统规划方法与公众和患者的经验性“非专家”主张之间相互作用的新兴文献增添了内容。
