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The implementation of General Practitioner Maternity Unit closure proposals in hospitals

By Yvon Dufour


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

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