An enquiry into the role of evidence in influencing the reconfiguration of stroke services in London

• Main Author: Fraser, Alec
• Other Authors: Baeza, Juan ; Boaz, Annette
• Published: King's College London (University of London) 2015
• Subjects: 658
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.677139

This thesis explores how changes in health service delivery are conceived of and pursued by different stakeholders. The thesis focuses on the importance of evidence to inform change. The London stroke service reconfiguration (2008-2011) is used as a case study to explore the interplay between evidence and the management of large-scale strategic change in health care. 45 semi-structured interviews were conducted with key stakeholders involved in the reconfiguration at both macro- and micro-levels through a pan-London case study with an embedded study at one London hospital affected by the reconfiguration. Observations of clinical meetings and analysis of official documentation was also performed. The study uses an ‘analytics of government’ (Dean, 2010) approach which is derived from Foucault’s (2007) work on ‘governmentality’ to interpretively explore the role of evidence in the reconfiguration process. This approach highlights the specific ways in which London’s stroke services were ‘problematised’ and explores the application of knowledge and techniques of power to address these issues. The discourse of evidence based health care is shown to be important in depoliticising potentially controversial strategic decisions. The advantages of conceptualising health service reconfigurations in ‘biopolitical’ terms are discussed. The impacts the reconfiguration had upon the relations between managers and professionals are analysed alongside a discussion around the interplay of disciplinary power and governmentality in the implementation of evidence based health care.