Table 2 Framework by Robert et al. (2014) rating factors in descending order, in terms of importance within each category, in shaping the extent to which decommissioning is implemented as planned

Change management and implementation strategy

• Strength of executive leadership

• Strength of clinical leadership

• Quality of communication

• Clarity of specific aims and objectives at start

• Extent of cultural and behavioral change

• Attention throughout to human aspects of process of change

• Quality of project management

• Availability of resources to support decision-making and implementation processes

• Quality of strategic planning

• Training and preparation of staff

• Clarity of incentives and levers to support change

• Complexity of decommissioning programme

• Pace of change

Evidence and information

• Demonstrable benefits

• Clarity of evidence/data to support business case, ongoing monitoring and impact assessment

• Clarity around new patient pathways

• Review/evaluation of process

• Availability of alternative services

• Extent of adoption elsewhere of new intervention/service

Relationships and political dimensions

• Clarity of rationale/case for change

• Nature and extent of clinician engagement/involvement

• Level of political support

• Transparency of decision-making process

• Nature and extent of patient/public engagement/involvement

• Quality of partnership working with relevant agencies

• Extent to which challenges vested interests

• Nature and extent of media coverage

• Stability within the local health economy during transition

• Reputation of existing providers

• Meets community expectations