the pervasiveness of power: dilemmas for researchers of major system change in healthcare; comment on “‘attending to history’ in major system change in healthcare in england: specialist cancer surgery service reconfiguration”

To study major system change (msc) in healthcare, it is crucial to consider the influence of power. despite this, dominant perspectives on msc in healthcare present these as relatively neutral processes, where reconfigurations are logical solutions to clearly defined problems. perry and colleagues’ paper adds to a growing body of research which challenges the presentation of msc as neutral, managerial processes, instead identifying how power dynamics lie at the heart of why service change happens, how it unfolds, and its outcomes. however, the introduction of power considerations raises several overlapping methodological and ethical dilemmas for researchers, and questions regarding research design and dissemination. in this commentary, we use the insights generated by perry et al to further explore these issues.