The implementation of General Practitioner Maternity Unit closure proposals in hospitals
This dissertation examines the 'implementation gap' and reports evidence on progress in implementing closure of health services at micro-implementation level. Specifically, the research develops an historically bound, processual and contextual account of the development and fate of permanent closures of General Practitioner Maternity Units (GPMU) in four neighbouring Oxford DHAs. The major objectives of this study are to illustrate and analyse the process by which the 'implementation gap' is closed and to identify. some of the potentially important factors which help to explain the pace and rate of change differential across health districts. The key questions, guiding the research include: What affects the pace of implementation? Why do districts fail or succeed in implementing change? What affects the 'implementability' of the GPMU closure proposals? To make further progress towards an understanding of implementation, this research adopts a new, eclectic, and integrative approach: the Contextualist Approach. One major theme underlying most of the results and ideas presented here, is that the outcome of implementation can be explained by the interplay between the content, the context and the process of implementation itself. The research is essentially qualitative. The data collection process comprises three main activities: documentary search, in-depth interviews, and ethnographic material. The strategy of data presentation and analysis was to develop a descriptive framework for organising the data (Yin, 1989). A set of three interacting groups of factors is found to affect implementability and rate and pace of change at micro-implementation level - the nature of the locale, leadership, and the quality of the proposal itself. Although other authors have studied health service policy, this research is unique in offering an extensive treatment of the changing policy context under investigation. It is also the first to investigate partial, as opposed to total, closure of hospitals within the context of the NHS, with particular emphasis on the GPMU.