Health Services Management Centre, University of Birmingham, Birmingham, UK.
Warwick Medical School, University of Warwick, Warwick, UK.
Sociol Health Illn. 2021 Feb;43(2):441-458. doi: 10.1111/1467-9566.13234. Epub 2021 Feb 26.
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.
医疗服务的关闭通常是一个高度复杂和有争议的过程，面临许多实施挑战。尽管可以从更广泛的政策实施和变革过程文献中获得一些见解，但对此现象的具体理论化研究却很少。在本文中，我们介绍了在英格兰国民保健服务中启动的三个关闭过程的实证案例研究结果。我们应用了莱文（Levine）（1979 年，《公共行政评论》，39（2），179-183）的关闭驱动因素分类法以及多元化医疗保健背景、复杂变革过程和制度约束的实证文献中的见解。数据包括访谈、非参与式观察和文件分析。除了常见的多元化和党派政治模式外，我们的研究结果还表明，制度因素在决定关闭过程的结果方面起着重要作用，特别是在服务成功关闭之前，需要具备政治脆弱性。与这种脆弱性程度相关的因素包括拟议变革的规模以及它们在宏观层面上得到支持的程度。
