A sociology of public responses to hospital change and closure.

Ellen Stewart

doi:10.1111/1467-9566.12896

Abstract

The “problem” of public resistance to hospital closure is a recurring trope in health policy debates around the world. Recent papers have argued that when it comes to major change to hospitals, “the public” cannot be persuaded by clinical evidence, and that mechanisms of public involvement are ill‐equipped to reconcile opposition with management desire for radical change. This paper presents data from in‐depth qualitative case studies of three hospital change processes in Scotland's National Health Service, including interviews with 44 members of the public. Informed by sociological accounts of both hospitals and publics as heterogeneous, shifting entities, I explore how hospitals play meaningful roles within their communities. I identify community responses to change proposals which go beyond simple opposition, including evading, engaging with and acquiescing to changes. Explicating both hospitals and the publics they serve as complex social phenomena strengthens the case for policy and practice to prioritise dialogic processes of engagement. It also demonstrates the continuing value of careful, empirical research into public perspectives on contentious healthcare issues in the context of everyday life.

Highlights

Building hospitals is not like building pyramids, the erection of memorials to endure to a remote posterity
Efforts to understand the complexity of public perspectives on healthcare change may reveal scope for compromise, both in shaping how publics value their health services, and in helping healthcare organisations to make decisions better-informed by the multiple “everyday” roles of healthcare facilities
The analysis presented in this paper is part of this wider grounded theory analysis of the full dataset Rather than the organisational approaches to change and consultation described in interviews with staff, I concentrate in this paper on my interviews with members of the public, in order to explore the specific question of community responses to hospital change

Summary

Introduction

Building hospitals is not like building pyramids, the erection of memorials to endure to a remote posterity. I argue that while the specific valued characteristics of hospitals vary, they can be helpfully understood not as shells within which services are provided but as socially-constructed “anchor institutions” which hold communities together. The implication of this argument is not that hospitals should never change or close, but that clinicallly or managerially-driven efforts to change them should acknowledge and offer alternative possibilities for these social roles. Efforts to understand the complexity of public perspectives on healthcare change may reveal scope for compromise, both in shaping how publics value their health services, and in helping healthcare organisations to make decisions better-informed by the multiple “everyday” roles of healthcare facilities

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Conclusion