Pawson, R, Greenhalgh, J orcid.org/0000-0003-2189-8879, Brennan, C orcid.org/0000-0002-5258-8497 et al. (1 more author) (2014) Do reviews of healthcare interventions teach us how to improve healthcare systems? Social Science and Medicine, 114. pp. 129-137. ISSN 0277-9536
Abstract
Planners, managers and policy makers in modern health services are not without ingenuity e 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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | ©2014 The Authors. Published by Elsevier Ltd. This is an open access article under the terms of the Creative Commons Attribution License, CC BY-NC-ND. |
Keywords: | United Kingdom; demand management; health systems; realist synthesis; organisational change; complexity |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Education, Social Sciences and Law (Leeds) > School of Sociology and Social Policy (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Academic Unit of Psychiatry and Behavioural Sciences (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 27 Jun 2014 14:11 |
Last Modified: | 26 Nov 2020 16:41 |
Published Version: | http://dx.doi.org/10.1016/j.socscimed.2014.05.032 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.socscimed.2014.05.032 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:79346 |