Changing hospitals

Achieving substantial change in hospitals is notoriously difficult and often takes many years. Perhaps the most striking example of protracted change comes from London, where proposals for relocating the central London teaching hospitals were first advanced in the 1890s (figure).1 Only now, over 100 years and more than 25 reports later, are some of these plans being implemented.

The obstacles to change are not explained by the standard texts on change management and little research into or evaluation of change management programmes in the NHS has been done. These subjects are difficult to research, and participants may be unwilling to expose themselves to external scrutiny. Developing generalisable lessons is difficult, particularly as local factors, especially politics, are often of great importance in determining the outcome. There are few peer reviewed journals for reporting what research does exist.

The lack of research has meant that we have based this article on our experiences and interviews with people who have been responsible for substantial programmes of change in Leeds, Sheffield, Newcastle, and London. We show the complexities of achieving change, identifying and reviewing obstacles that have derailed programmes, and the resolutions found in specific cases. There is no panacea, but some factors can help in achieving success. Four obstacles have hindered hospital reconfigurations: opposition from stakeholders; funding; inadequate processes for developing and consulting on the plan; and absence of a shared understanding of policy direction.