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Misalignment between policy and staff experience: the case of an Australian hospital redevelopment

Chiara Pomare (Macquarie University, Sydney, Australia)
Kate Churruca (Macquarie University, Sydney, Australia)
Janet C. Long (Macquarie University, Sydney, Australia)
Louise A. Ellis (Macquarie University, Sydney, Australia)
Jeffrey Braithwaite (Macquarie University, Sydney, Australia)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 15 February 2021

Issue publication date: 8 June 2021




Hospitals are constantly redeveloping to improve functioning and modernise the delivery of safe and high-quality care. In Australia, it is expected that different stakeholders have the opportunity to contribute to the design and planning of hospital redevelopment projects. The purpose of this study is to examine the potential for misalignment between policy (“work as imagined”) and staff experiences of a hospital redevelopment (“work as done”).


A case study of a large Australian hospital in a capital city undergoing redevelopment. Forty-six semi-structured interviews were conducted with hospital staff. Staff experiences were identified in corroboration with additional data: key-informant discussions with members of the hospital executive; document analysis (e.g. hospital and government documents) and survey responses about experiences of the hospital redevelopment.


A disjuncture was identified between policy and the experiences of hospital staff. Over one in every three (36.0%) staff felt uninformed about the redevelopment and 79.4% were not involved in decisions throughout the process of design and redevelopment, which contradicted the procedure laid out in policy for hospital development.


Despite the seemingly “good news story” of allocating billions of dollars to redeveloping and modernising health services in Australia, the experiences of staff on the front lines suggest a lack of consultation. Rectifying these concerns may be integral to avoid fragmentation during the challenging circumstances of hospital redevelopment.



Declarations Ethics approval and consent to participate: The study was approved by the relevant Ethics Committee in Sydney, New South Wales, Australia (no: 18/233). Due to ethical requirements, the committee cannot be named because it may lead to the identification of the study site. Written consent was obtained from all study participants.Consent for publication: Not applicable.Availability of data and material: The datasets analysed during the current study are not publicly available due to individual privacy, but are available from the corresponding author on reasonable request.Competing interests: The authors declare that they have no competing interests.Funding: CP was funded by the Australian Government Research Training Program (RTP) PhD Scholarship. JB is supported by multiple grants, including the National Health and Medical Research Council (NHMRC) Partnership Grant for Health Systems Sustainability (ID: 9100002). The funders had no role in the design, analysis and drafting of the manuscript.Authors' contributions: CP drafted the initial manuscript. CP performed the analysis and KC, JCL, LAE and JB contributed to interpretation of findings. All authors contributed to the refinement of the final manuscript.


Pomare, C., Churruca, K., Long, J.C., Ellis, L.A. and Braithwaite, J. (2021), "Misalignment between policy and staff experience: the case of an Australian hospital redevelopment", Journal of Health Organization and Management, Vol. 35 No. 4, pp. 511-522.



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