Dufour, Yvon (1991) The implementation of General Practitioner Maternity Unit closure proposals in hospitals. PhD thesis, University of Warwick.

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Abstract

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.

Item Type:	Thesis (PhD)
Subjects:	R Medicine > RA Public aspects of medicine
Library of Congress Subject Headings (LCSH):	Hospital closures -- England -- Oxford, Health planning -- Great Britain, Organizational change -- Great Britain, Maternal health services -- England -- Oxford
Official Date:	April 1991
Dates:	Date Event April 1991 Submitted
Institution:	University of Warwick
Theses Department:	School of Industrial and Business Studies
Thesis Type:	PhD
Publication Status:	Unpublished
Extent:	537 leaves
Language:	eng

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