Do reviews of healthcare interventions teach us how to improve healthcare systems?

TY - JOUR

T1 - Do reviews of healthcare interventions teach us how to improve healthcare systems?

AU - Pawson, Ray

AU - Greenhalgh, Joanne

AU - Brennan, Cathy

AU - Glidewell, Elizabeth

N1 - Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

PY - 2014/8

Y1 - 2014/8

N2 - Planners, managers and policy makers in modern health services are not without ingenuity - they will always try, try and try again. They face deep-seated or 'wicked' problems, which have complex roots in the labyrinthine structures though which healthcare is delivered. Accordingly, the interventions devised to deal with such stubborn problems usually come in the plural. Many different reforms are devised to deal with a particular stumbling block, which may be implemented sequentially, simultaneously or whenever policy fashion or funding dictates. This paper examines this predicament from the perspective of evidence based policy. How might researchers go about reviewing the evidence when they are faced with multiple or indeed competing interventions addressing the same problem? In the face of this plight a rather unheralded form of research synthesis has emerged, namely the 'typological review'. We critically review the fortunes of this strategy. Separating the putative reforms into series of subtypes and producing a scorecard of their outcomes has the unintended effect of divorcing them all from an understanding of how organisations change. A more fruitful approach may lie in a 'theory-driven review' underpinned by an understanding of dynamics of social change in complex organisations. We test this thesis by examining the primary and secondary research on the many interventions designed to tackle a particularly wicked problem, namely the inexorable rise in demand for healthcare.

AB - Planners, managers and policy makers in modern health services are not without ingenuity - they will always try, try and try again. They face deep-seated or 'wicked' problems, which have complex roots in the labyrinthine structures though which healthcare is delivered. Accordingly, the interventions devised to deal with such stubborn problems usually come in the plural. Many different reforms are devised to deal with a particular stumbling block, which may be implemented sequentially, simultaneously or whenever policy fashion or funding dictates. This paper examines this predicament from the perspective of evidence based policy. How might researchers go about reviewing the evidence when they are faced with multiple or indeed competing interventions addressing the same problem? In the face of this plight a rather unheralded form of research synthesis has emerged, namely the 'typological review'. We critically review the fortunes of this strategy. Separating the putative reforms into series of subtypes and producing a scorecard of their outcomes has the unintended effect of divorcing them all from an understanding of how organisations change. A more fruitful approach may lie in a 'theory-driven review' underpinned by an understanding of dynamics of social change in complex organisations. We test this thesis by examining the primary and secondary research on the many interventions designed to tackle a particularly wicked problem, namely the inexorable rise in demand for healthcare.

KW - Delivery of Health Care

KW - Evidence-Based Medicine

KW - Humans

KW - Organizational Innovation

KW - Quality Improvement

KW - United Kingdom

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

KW - Review

U2 - 10.1016/j.socscimed.2014.05.032

DO - 10.1016/j.socscimed.2014.05.032

M3 - Review article

C2 - 24929647

SN - 0277-9536

VL - 114

SP - 129

EP - 137

JO - Social science and medicine

JF - Social science and medicine

ER -