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Changing health care with, for, or against the public : an empirical investigation into the place of the public in health service reconfiguration

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Date
01/01/2021
Author
Greer, Scott L.
Stewart, Ellen
Ercia, Angelo
Donnelly, Peter
Keywords
Public participation
Service reconfiguration
United Kingdom
RA0421 Public health. Hygiene. Preventive Medicine
Health Policy
Public Health, Environmental and Occupational Health
E-NDAS
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Abstract
Objectives: This study sought to understand the different approaches taken to involving the public in service reconfiguration in the four United Kingdom health systems. Methods: This was a multi-method study involving policy document analysis and qualitative semi-structured interviews in England, Northern Ireland, Scotland and Wales. Results: Despite the diversity of local situations, interview participants tended to use three frames within which they understood the politics of service reconfigurations: an adversarial approach which assumed conflict over scarce resources (change against the public); a communications approach which defined the problem as educating the public on the desirability of change (change for the public); and a collaborative approach which attempted to integrate the public early into discussions about the shape and nature of desirable services (change with the public). These three framings involved different levels of managerial time, energy, and resources and called on different skill sets, most notably marketing and communications for the communications approach and community engagement for the collaborative approach. Conclusions: We argue that these framings of public involvement co-exist within organisations. Health system leaders, in framing service reconfiguration as adversarial, communicative or collaborative, are deciding between conceptions of the relationship between health care organisations and their publics in ways that shape the nature of the debates that follow. Understanding the reasons why organisations adopt these frames would be a fruitful way to advance both theory and practice.
Citation
Greer , S L , Stewart , E , Ercia , A & Donnelly , P 2021 , ' Changing health care with, for, or against the public : an empirical investigation into the place of the public in health service reconfiguration ' , Journal of Health Services Research and Policy , vol. 26 , no. 1 , pp. 12-19 . https://doi.org/10.1177/1355819620935148
Publication
Journal of Health Services Research and Policy
Status
Peer reviewed
DOI
https://doi.org/10.1177/1355819620935148
ISSN
1355-8196
Type
Journal article
Rights
Copyright © The Author(s) 2020. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
Description
Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by the Health Foundation.
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  • University of St Andrews Research
URI
http://hdl.handle.net/10023/24442

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