Intended for healthcare professionals

Education And Debate The hospital of the future

Changing hospitals

BMJ 1999; 319 doi: (Published 06 November 1999) Cite this as: BMJ 1999;319:1262
  1. Jane Haycock, senior health economista,
  2. Anna Stanley, consultanta,
  3. Nigel Edwards, policy director (,
  4. Robert Nicholls, independent consultanta
  1. a London Health Economics Consortium, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. b NHS Confederation, London SW1P 4ND
  1. Correspondence to: N Edwards

    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.

    Summary points

    The difficulties of achieving change in hospital systems cannot be underestimated

    The public seems to be unimpressed by a number of the arguments used by health planners to support major change

    The absence of a base of good evidence to inform planning is a big problem

    Many plans fail because of a lack of political commitment, resources, and consensus between the main stakeholders

    Opposition from stakeholders

    The public, clinicians, …

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