Trisha Greenhalgh|Christopher Humphrey|Jane Hughes|Fraser Macfarlane|Ceri Butler|Ray Pawson
How Do You Modernize a Health Service? A Realist Evaluation of Whole?Scale Transformation in London
University College London|University of Leeds|University of Surrey|King's College London|University College London|University of Leeds|University of Surrey|King's College London|University College London|University of Leeds|University of Surrey|King's College London|University College London|University of Leeds|University of Surrey|King's College London|University College London|University of Leeds|University of Surrey|King's College London|University College London|University of Leeds|University of Surrey|King's College London
largescale wholesystems interventions health care require imaginative approaches evaluation go beyond assessing progress predefined goals milestones project evaluated major change effort inner london funded charitable donation approximately 21 million spanned four large health care organizations covered three services stroke kidney sexual health sought modernize services view making health care efficient effective patient centeredthis organizational case study draws principles realist evaluation largely qualitative approach centrally concerned testing refining program theories exploring complex dynamic interaction among context mechanism outcome approach used multiple data sources methods pragmatic reflexive manner build picture case follow fortunes threeyear study period methods included ethnographic observation semistructured interviews scrutiny documents contemporaneous materials well providing ongoing formative feedback change teams specific areas activity undertook abstract interpretive analysis explored contextmechanismoutcome relationship using guiding question works circumstancesin example largescale service transformation numerous projects subprojects emerged fed one another evolved time six broad mechanisms appeared driving efforts change agents integrating services across providers finding using evidence involving service users modernization effort supporting selfcare developing workforce extending range services within mechanisms different teams chose widely differing approaches met differing success realist analysis fortunes different subprojects identified aspects context mechanism accounted observed outcomes intended unintendedthis study one first applications realist evaluation largescale change effort health care even ambitious change program shifts original goals meets unforeseen challenges indeed precisely program morphs adapts time realist evaluation draw useful lessons particular preconditions make particular outcomes likely even though cannot produce predictive guidance simple recipe success noting recent calls others greater use realist evaluation health care article considers challenges limitations method light experience suggests use require fundamental changes worldview health services researchers