Managing major health service and infrastructure transitions: A comparative study of UK, US and Canadian hospitals

increasingly common as health systems evolve in response to innovations and process improvements, and to the changing demands for healthcare. Sometimes new health service designs need to be supported by changes to the healthcare infrastructure if they are to be successfully implemented and sustained ? service delivery models and its built and technical infrastructure must be transformed simultaneously. Just tackling one of these issues is challenging for all involved. Doing both these tasks at the same time can be overwhelming and risky. But there can also be advantages in such radical change. It can provide an opportunity to radically rethink ways of delivering healthcare. Conducting simultaneous infrastructure renewal and service redesign means that care processes, not plausible in the old infrastructure, may be more easily designed into the new facility. Major restructuring efforts are rarely systematically evaluated with outcomes measured or best practice shared (Walston and Chadwick, 2003). However, we do know that ?whole system? organisational change in healthcare ? change which impacts on all areas of the organisation across all levels and stakeholder groups ? is often hampered by a failure to plan effectively (NHS, 2008). It is generally accepted that the successful introduction of healthcare innovations requires the approval of relevant stakeholders (e.g. physicians, government bodies, primary care providers), and that planning and implementing major changes in healthcare service or infrastructure design requires practice- based examples to learn from. While there is considerable experience in the planning and implementation of health services changes, there is little written about combined services and infrastructure change. Organisations searching for such information may have to look for examples beyond those found in their own country. Studying similar cases across different organisational and international contexts also increases the likelihood of determining pivotal factors that underpin success