A critical examination of the hospital restructuring process in Ontario, Canada Toba Bryant Centre for Health Studies, York University, 4700 Keele Street, Toronto, Ont., Canada M3J 1P3 Received 2 February 2002; accepted 31 July 2002 Abstract Little work has been done to consider the roles of different forms of knowledge and civil society actors in health policy development. Research on the role of knowledge in policy change has focussed on the contributions of social science knowledge and social scientists. This view assumes that the perspectives and knowledge of experts are the only valid input into the process and is non-critical in its analysis of health policy and health inequities. This paper challenges the reliance upon certain types of knowledge that are brought to bear on the health policy change process, and that knowledge and its creation are impartial activities. This paper presents a conceptual framework of health policy change that incorporates broad concepts of knowledge and civil society actors as contributing to health policy development. It also demonstrates the different dynamics that impinge upon knowledge and its use in health policy change. A case study on hospital restructuring in Toronto, Canada, is presented. Women’s College Hospital fought recommended closure and merging of its inpatient services with Sunnybrook Health Science Centre. The case study examined the selection and use of knowledge by the Hospital in building its case against closure. # 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Health policy; Hospital restructuring; Ontario health policy change; Women’s College Hospital 1. Introduction Remarkably little work considers how different forms of knowledge can contribute to health policy development. What research has been done has analysed how the knowledge of health and social science experts contribute to the devel- opment of policy [1,2]. Such a view takes for granted that perspectives and knowledge of ex- perts constitute the only forms of valid input into this process [3  /5]. This belief persists despite increasing calls for citizen involvement in the health policy process. Some analysts suggest that consumer involvement in health policy develop- ment would improve the quality of health care and service [6]. The experiences of citizens within the system would provide insights less likely to emanate from experts whose frameworks are grounded in the E-mail address: toba.bryant@sympatico.ca (T. Bryant). Health Policy 64 (2003) 193  /205 www.elsevier.com/locate/healthpol 0168-8510/02/$ - see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved. PII:S0168-8510(02)00157-4